Question: I am experiencing a lost sense of smell after surgery. I had an upper left molar tooth extracted last month. The extraction was painful, for more than 20 min. the dentist pushed my head, pulled and twisted the molar. I had a sinus perforation which later was confirmed through a dental x-ray (not panoramic or whole head).
Please can someone tell me whether my anosmia is going to be permanent (one month already) and whether I might have had the CSF leak due to the blunt trauma of the tooth extraction and sinus perforation? The liquid did not resemble any mucus, it was watery and sudden gush. I am still waiting for the day where a surgery will be done to close the sinus communication via cutting and stitching on my gums (it will be after 3 weeks).
Is anosmia typical for sinus perforation? I have a burning sensation in the base of my left nostril and a feeling of excessive dryness. For a week or so I started having a mucous liquid running down to my throat, I am sure that this is from the sinus.
Answer:
First of all, thank you for your question. This obviously has been a difficult time for you. I will try to answer your question(s) as best as possible, without having examined you.
It is not rare for someone experience a lost sense of smell after surgery. Typically because they develop a sinus infection after an upper molar infection or extraction. The roots of the upper molars are very close to and sometimes in the maxillary sinus. The bacteria that we have in our mouth can then spread into the sinus easily causing infection. The bacteria of the oral cavity, in particular, tend to be worse than those we have living normally in our nose and sinuses, and can cause quite significant infections.
It seems likely, that you had a sinus infection from your dental problem. This needs to be treated aggressively, with antibiotics based on a culture of your sinus discharge- and sometimes by drainage- surgically or with a balloon sinuplasty (balloon dilating of the normal opening of the sinus – done in the office.
You can certainly have a temporary- or even permanent loss of the sense of smell (anosmia) from infection. One needn’t postulate a break in the roof of the sinus (cribiform plate)- Although your description of the mucous drainage is consistent with a leak of brain fluid (CSF)- the best way to diagnose this would be to collect the fluid and to have it tested – (Beta Transferin is used as a marker)- Even less likely would be a leak of fracture of the petrous apex (inner ear)- as this usually will cause a hearing loss from fluid collecting in the middle ear- and will not often cause drainage through the nose.
Certainly, I would suggest CT scanning of the sinuses to make sure you do not have a persistent infection- and to look at the area where one could find a tear causing a leak of brain fluid into the nose. I am not sure how a dental extraction could cause a fracture of the roof of the sinuses, however.
Lastly, one needs to find out the cause of your loss of smell to give you the best idea of how to treat this and whether the lost sense of smell after surgery will eventually disappear.
If there is a persistent infection of the sinuses, it certainly can cause loss of smell and your sense of smell will usually (not always) return once the infection has resolved.
If you have a leak of brain fluid, (CSF Rhinorrhea)- that needs to be treated-
Traumatic anosmia- loss of smell from head trauma- has a less favorable outlook than other causes.
In any case- you should really be seen and evaluated by an Ear Nose and Throat doctor- or sinus specialist (rhinologist) who deals with smell and taste problems to see what you should do next.
I hope this clears things up.
Robert Pincus MD
Associate Professor Otolaryngology NY Medical College
Co-Director NY Sinus Center
Frequently Asked Questions
Yes, anosmia can occur after upper molar tooth extraction, especially if a sinus infection develops. Since the roots of upper molars are close to the maxillary sinus, bacteria from the mouth can infect the sinus, potentially leading to loss of smell. Treating the infection promptly often helps restore the sense of smell.
A CSF leak from dental extraction is less common but possible if there is trauma causing a tear in the sinus roof. The watery, sudden gush of fluid described may suggest CSF rhinorrhea, which requires testing of the fluid for confirmation. Such leaks need medical evaluation and treatment to prevent complications.
The cause of anosmia can be diagnosed through clinical evaluation, imaging such as CT scans of the sinuses, and testing any nasal drainage (e.g., for CSF markers like beta-2 transferrin). A specialist evaluation by an ENT or rhinologist is essential to determine if anosmia is due to infection, CSF leak, or other causes.
Anosmia resulting from a sinus infection is usually temporary and improves once the infection is treated effectively with antibiotics and sometimes drainage. However, in some cases, smell loss can persist if severe damage occurs. Prompt treatment increases the chances of recovery.
Treatment options include antibiotic therapy to address infection, surgical interventions like closure of the sinus perforation via gum surgery, or balloon sinuplasty to improve sinus drainage. If a CSF leak is present, specific surgical repair is necessary. Close follow-up with a sinus specialist is important.
Yes, seeing an Ear, Nose, and Throat (ENT) specialist or a rhinologist is highly recommended. They have the expertise to evaluate and manage smell loss, determine if there is infection or CSF leak, and advise on appropriate treatment to improve symptoms and prevent complications.
