Punctured Sinus After Dental Procedure: Recognition and Management

Oroantral communication (OAC) occurs when maxillary molar/premolar extraction or implant breaches the Schneiderian membrane.

Symptoms

• Air/fluid passage between mouth and nose (bubbles on Valsalva).
• Unilateral nasal congestion, serosanguinous discharge.
• Pain/pressure in cheek, infraorbital region.
• Altered speech resonance (hypernasality).
• Possible infection → sinusitis (fever, purulent discharge).

Diagnosis

• Clinical: Valsalva maneuver visualization, probe passage (gentle).
• Imaging: CBCT (cone-beam CT) defines defect size, location, sinus pathology.

Management

• <2 mm: Often spontaneous closure; socket preservation, antibiotics, avoid Valsalva/sneezing open-mouthed.
• 2–5 mm: Collagen plug, PRF, buccal fat pad advancement, or surgical closure.
• >5 mm or persistent >3 wk: Surgical flap (buccal advancement, palatal rotation) by oral surgeon.

Prophylaxis

Pre-op CBCT for root-sinus proximity; careful technique; primary closure if perforation recognized intraoperatively.

Early recognition and tiered management prevent chronic sinusitis and fistula.