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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest treatment for acute sinusitis

Hello, on 4/18 I had all top teeth removed because of gum disease or because of 14 different medications prescribed by my Drs not really sure which was the reason . After extractions I had foul smell in sinus', s and pain in left ear eyes and throat went back to dentist on 4/27 dentist he said that's very strange, looked in my mouth and said that everything is healing well and that I probably have sinus issues, but gave me penicillian 500 mg. On 5/9 still had the foul smell he looked in my mouth and again said everything is healing well and he has no idea why I have that smell but gave me azrithromycin 250 dose pack and dexamethasone oral solution and said that I probably have sinus issues. On 6/1 I went to ENT who looked in my mouth and ear, because at this point my ear is totally clogged, I had explained about the extractions, she put me on Levoflaxin 500 mg and Fluticasone 50 mg told me to buy nasal rinse and sudafed and come back in two weeks if nothing changes ( I was the last patient of the day, not that that should matter but maybe that's why I was ONLY given meds). But at this point I started having sever pain in right hip and left shoulder I went to ER for CT was told I have synovial cyst in hip and possible torn rotator cuff and to go get MRI, so I asked my GP to send me for MRI of hip and shoulder and sinus CT since I still had sinus issue. On 6/13 the report from sinus Ct is as follows: Findings : the frontal sinus is aplastic, right sinus clear sphenoid sinus and sphenoethmodial recess are clear ,right maxillary sinus and ostiomeatal complex appear unremarkable. There is a 2 mm cell on right. The nasal septum is deviated to the left. There is complex opacification of the left maxillary. Within the left maxillary sinus, there is a density which may represent a tooth. This area measures approximately 1.4 mm in greatest dimension. The left maxillary sinus is totally opacified. There is a boney defect of the left maxilla near the maxillary sinus antrum. This has an AP dimension of 4 mm and there is superior displacement of the bone in this area extending into the left maxillary sinus. The left ostiomeatal complex is occluded. The orbital walls are intact. No soft tissue swelling of the facial region. IMPRESSIONS:
1. Complex opacification of left maxillary sinus
2.There appears to be a tooth in the left maxillary sinus. This density could otherwise represent cement. It has a greatest dimension of 1.4 cm in the axial plane.
3. There is a bony defect in the floor of the left maxillary sinus. This may represent an oromaxillary fistula. This constellation of findings could represent acute sinusitis infection within the left maxillary sinus. There is no evidence of periosteal reaction or bone loss elsewhere with the exception of the bony defect described above.
MY QUESTION TO YOU IS what does all of this mean in laymen terms (since I've not yet picked up MRI reports) is it possible that whatever is happening in my sinus's has anything to do with cysts and pain that I'm experiencing in my joints. AND what type of specialist do you recommend that I should see if these joint issues are the result of some type of infection. I believe that when dentist was making mold that it was pushed up into a large hole that the dentist did not sew up, he said because it was too far back, he did stitch all other areas except the top back tooth. Plus he made me go back THREE different times because he didn't like the way the first 3 looked or fit. I am still suppose to go back for the permanent denture......one more question....knowing what you now know, SHOULD I ever go back to this dentist? I'm so sorry for the long questonS, but I've had very poor luck (to say the least ) with dentists and don't know who to trust for straight answers and proper help. Thank you so much for your time.
Fri, 19 Aug 2016
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Dentist 's  Response
Hi..
Welcome to HEALTHCARE MAGIC..

I have gone through your query and can understand your concerns..

As per your complain there is some structure apparent in your left sinus and is probably a tooth which must have slipped into the sinus while extraction and it has led to infection in the sinus and opacification is due to filling up of the sinus with pus as a result of infection..

Secondly the roots of upper back teeth are in close contact with the floor of the maxillary sinus and at times during extraction the floor can become perforated and leads to a through and through opening and communication between the mouth and sinus that can inturn cause infection in sinuses..

Both these conditions are causing infection in sinuses..

You should consult an ENT surgeon and get evaluated and he can evaluate your sinus MRI and if the sinus has a tooth then it has to be surgically removed along with draining of the sinuses.It will be followed by antibiotics and decongestants..

Once the infection is completely resolved and the sinus floor is repaired then you can very much go for denture fabrication..

Pain in your joints is not related to your sinus infection and you need to consult an Orthopedician for this..

Hope this information helps..

Thanks and regards.
Dr.Honey Nandwani Arora.
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Suggest treatment for acute sinusitis

Hi.. Welcome to HEALTHCARE MAGIC.. I have gone through your query and can understand your concerns.. As per your complain there is some structure apparent in your left sinus and is probably a tooth which must have slipped into the sinus while extraction and it has led to infection in the sinus and opacification is due to filling up of the sinus with pus as a result of infection.. Secondly the roots of upper back teeth are in close contact with the floor of the maxillary sinus and at times during extraction the floor can become perforated and leads to a through and through opening and communication between the mouth and sinus that can inturn cause infection in sinuses.. Both these conditions are causing infection in sinuses.. You should consult an ENT surgeon and get evaluated and he can evaluate your sinus MRI and if the sinus has a tooth then it has to be surgically removed along with draining of the sinuses.It will be followed by antibiotics and decongestants.. Once the infection is completely resolved and the sinus floor is repaired then you can very much go for denture fabrication.. Pain in your joints is not related to your sinus infection and you need to consult an Orthopedician for this.. Hope this information helps.. Thanks and regards. Dr.Honey Nandwani Arora.