Question: I had punctured sinus during left molar extraction. The socket was not closed properly and needed repair work 4 days later to close socket. I have had bouts of nasal congestion, burning sensation in nasal cavity, light headedness. Tilting my head back seems to help sometimes. I am not sure my sinus healed properly. Have had pulling sensation in left nostril. Noises in left ear have been diagnosed as eustachian tube dysfunction. First problem with ear was suctioning sound when I yawned (socket had sealed). Then clicks when congested. Now clicks randomly. Can an MRI show if my punctured sinus has healed properly or is a CT scan required?
Answer: First of all, thank you for your question. The roots of several teeth- especially our molars, can be quite close or actually within the maxillary (cheek) sinus. Infections in the tooth roots or dental extractions can spread infection into the sinus- and are typically difficult to treat as the oral bacteria are often quite virulent.
Treating odontogenic (dental caused) sinus infections involves appropriate antibiotics- usually best based on an actual culture- and treating the dental problem.
Today, we will often use balloon sinuplasty- opening up the sinus with a balloon in the office- to drain the sinuses if needed.
The best way to see if a sinus infection has resolved is with CT scanning. Low dose scans can be done, and while the radiation is less than with typical scans, there still is some radiation. MRI’s use electromagnetic waves rather than radiation, but do not show bone- and tend to over read sinus problems. They are much less useful, but a normal sinus MRI would probably be enough to avoid using CT scanning.
I hope this clears things up.
Robert Pincus MD, FACS
Co-director NY Sinus Center
Frequently Asked Questions
A punctured sinus during molar extraction can occur because the roots of the upper molars are very close to or may extend into the maxillary sinus. During extraction, these thin bone walls can be breached, creating an opening between the mouth and sinus.
Symptoms such as nasal congestion, burning sensations in the nasal cavity, pulling sensations in the nostril, and ear noises like clicks or suction sounds may indicate complications in sinus healing after dental extraction. These symptoms result from disrupted sinus function or infections.
MRI uses electromagnetic waves and is less effective for viewing bone structures. It tends to overread sinus problems and does not clearly show bone healing. While a normal sinus MRI might reduce the need for CT, it is generally less useful for assessing healing of a punctured sinus.
Yes, CT scanning is the preferred method to assess whether a punctured sinus has healed properly because it provides clear images of bone and sinus anatomy. Low-dose CT scans minimize radiation exposure while effectively showing sinus infection resolution or persistent defects.
Odontogenic sinus infections are treated with appropriate antibiotics, ideally based on a culture to target specific bacteria, and addressing the underlying dental issue. Balloon sinuplasty is also used to open and drain the sinus if needed to help resolve infection and restore sinus function.
Ear symptoms like clicking or suctioning sounds can occur due to Eustachian tube dysfunction, which may result from sinus infections or congestion affecting pressure regulation in the ear. These symptoms can fluctuate with sinus healing and congestion levels.
