Reviewed by Dr. Hardeep Dhaliwal
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Reading time: three minutes
A sinus perforation is a small opening between the mouth and the maxillary sinus that can occur after removing an upper back tooth. While it can sound alarming, it’s usually treatable and most patients recover fully with proper care.
Table of Contents
What Is a Sinus Perforation?
A sinus perforation (oroantral communication) occurs when the thin bone that separates the upper tooth roots from the sinus floor is opened during extraction. Upper molars sit close to the sinus, and in some people, the bone is naturally very thin.
When that barrier is disrupted, air, fluids, or bacteria can potentially move between the mouth and sinus until it heals or is surgically closed.
Symptoms of a Sinus Perforation
Most perforations cause noticeable symptoms early on, although signs can vary from patient to patient.
Watch for:
- Air passing between the mouth and nose when breathing
- Whistling sound when speaking
- Fluid leaking from nose when drinking
- A feeling of pressure changes between the mouth and sinus
- Persistent nasal congestion
- Nasal discharge
- Bad taste or drainage if infection develops
If you notice these symptoms, contact your surgeon right away.
How Oral Surgeons Diagnose a Sinus Perforation
Your surgeon will evaluate the extraction site and may take imaging to confirm the size of the opening. Diagnosis usually involves:
- Visual exam
- Gentle nose-blowing tests (performed by the clinician only)
- Cone beam CT (CBCT) for detailed sinus anatomy
This helps determine the best treatment approach.
Treatment Options for Sinus Perforation
Treatment depends on the size of the perforation and the symptoms. Small openings often heal without surgery.
1. Small perforations (1–2 mm)
These openings are minor and often close naturally with proper care.
- Usually heal on their own
- Oral surgeon may place a collagen plug or suture to protect the area
- Antibiotics and sinus precautions may be recommended
2. Moderate perforations
These require additional support to help the sinus membrane close fully.
- Closure with a membrane or soft-tissue sutures
- Possible use of platelet-rich fibrin (PRF) to support healing
3. Large or persistent perforations
These openings need surgical repair to restore the barrier between the mouth and sinus.
- Surgical closure with a buccal fat pad flap or palatal flap procedure
- Bone grafting may be required to rebuild the sinus floor
How to Prevent a Sinus Perforation
Patients play an important role in protecting the extraction site while it heals. These precautions help reduce strain on the sinus and lower the chance of an opening forming or enlarging.
- Do not blow your nose
- Keep your mouth open when sneezing
- Avoid straws
- Avoid smoking
- Skip heavy lifting or bending over
- Avoid forceful rinsing or spitting
These steps support healthy healing and help the sinus membrane close properly.
How to Choose a Qualified Surgeon
Choosing the right surgeon plays a significant role in reducing complications and ensuring proper care if a sinus perforation occurs. When evaluating a provider, consider the following:
- Look for specialized training. Oral and maxillofacial surgeons have advanced expertise in sinus anatomy, surgical technique, and managing complications.
- Ask whether they use CBCT imaging. Three-dimensional imaging helps identify thin sinus floors and supports safer treatment planning.
- Discuss their experience with upper molar extractions. These teeth sit closest to the sinus, so experience with complex cases is important.
- Review their approach to perforation management. A qualified surgeon should explain how they prevent, diagnose, and treat sinus openings.
- Confirm availability for follow-up care. Complications can develop after hours, so make sure your surgeon is accessible for questions or concerns.
These steps help you choose a provider who prioritizes safety, precision, and a smooth recovery.
Schedule Your Oral Surgery Consultation in Issaquah, WA
For comprehensive oral and maxillofacial surgery supported by advanced imaging, precise techniques, and attentive follow-up, schedule your visit at Adara Surgical Institute.
To book an appointment at our oral surgery office in Issaquah, WA, call (425) 428-5888 or visit us at 6505 226th Pl SE STE #100 Issaquah, WA.
FAQs
Can a sinus perforation heal on its own?
Small openings often close naturally with proper care and sinus precautions.
How do I know if the extraction site opened into my sinus?
Symptoms like whistling sounds, air movement between mouth and nose, or fluid leaking from your nose after drinking suggest a perforation.
Is sinus perforation common?
It’s not extremely common, but it’s more likely after upper molar extractions because these roots sit close to the sinus.
Can I blow my nose after a sinus perforation?
Avoid nose-blowing for at least 1–2 weeks or as directed. Avoid any activities that increase sinus pressure as this can reopen the site.
Is a Sinus Perforation Dangerous?
Most cases are mild and heal on their own. However, leaving a noticeable opening untreated increases your risk of sinus infection, delayed healing, or a chronic oroantral fistula (a persistent hole).
