Mouth-sinus hole (oro-antral communication): Day Surgery Unit

About a mouth-sinus hole

A mouth-sinus hole is a hole that forms between your mouth and the air-filled space either side of your nose, inside your cheekbones. This space is called your sinus.

This type of hole can happen if:

• you have a tooth taken out (extracted). This is because the roots of your upper molar teeth and your sinus are so close together.
• we are trying to remove a fragment of tooth-root that may have broken off during an extraction. As a result, liquids move from your mouth into your sinus and out through your nose.

If the hole is left untreated, it can cause infection and continuing fluid leakage from your mouth to your nose.

The medical name for a mouth-sinus hole is 'oro-antral communication'.

Symptoms

The symptoms of a mouth-sinus hole are as follows.

• Your tooth extraction site does not heal.
• You feel fluid or food go into your nose when you eat or drink.
• You feel air rush across the tooth extraction area when you breathe.
• You keep getting a sinus infection.
• You experience pain or tenderness under your eye or upper cheek.
• One side of your nose is blocked or produces discharge.
• You experience a one-sided throbbing pain or pressure in your nose.

Treatment

A mouth-sinus hole often heals itself, especially if it is small.

If it is a little bigger, we may need to close it surgically, to create a barrier between your mouth and your sinus.

We usually close the hole by using part of your gum around the area and some of the skin in your mouth. We use dissolving stitches to do this, which cover the hole while it heals. These stitches disappear after 2 to 3 weeks.

To carry out this procedure, we give you a local anaesthetic (a numbing injection into your gum). 

This is a painless procedure and it is effective for 95% of patients.

Occasionally a patient may need further surgery. This may involve another repair, which we perform while you are under general anaesthetic (asleep) at a future date.

When you get home

It is safe for you to drive yourself home after the procedure.

Medications

The human mouth contains bacteria. This is normal, but the bacteria can contaminate your surgery wound or your sinus. To stop this happening, we may prescribe the following.

• A 5 or 7 day antibiotic course. 
• A nasal decongestant (to relieve a blocked nose) such as Ephedrine, to use for up to 7 days. This is not suitable if you have any of the following:
  • cardiovascular disease
  • hypertension
  • diabetes
  • depression which is being treated with medication. 
• Steam inhalations, for example with menthol or eucalyptus oil such as Olbas. This will help to moisten your airways and stop blood and mucus crusting in your sinus. To make a steam inhalation, do the following.
  • In a bowl, add 1 teaspoon of menthol or eucalyptus oil to 500mls of hot water.
  • Cover your head with a towel and hold your head 15 to 30 cm away from the bowl.
  • Breathe in (inhale) the steam coming from the bowl, for 5 minutes.
  • Repeat this every 6 hours. 

Everyday activities 

For 3 weeks after your procedure

• Stick to soft foods. Do not eat hard or chewy foods.
• Do not blow your nose, even though your sinus may feel stuffy or fluids may drain slightly from your nose.
• Do not pinch your nostrils while sneezing.
• Do not use a straw to drink
• Do not smoke or vape.

All of these actions can raise pressure in your sinus and cause the wound to break open again. Smoking can also lead to infection in your wound.

For 6 weeks after your procedure

• Do not fly in an aircraft
• Do not blow up balloons
• Do not play a wind or brass instrument
• Do not go scuba diving.

Follow-up

To check how you are healing after your treatment, we will give you an appointment 2 to 3 weeks after your surgery. This will take place in the Kingston Hospital Princess Alexandra Wing.