I have pain after oroantral fistula surgery. How to manage?

Question

Hello doctor,

I had oroantral fistula surgery one month before. Some important information: They pulled the tooth and told me it is good. But the socket did not heal, there was pus, and I was in pain.

Six weeks after the extraction, I went to an oral surgeon, and he was in shock that the dentist did not tell me to go and visit an oral surgeon. He had to make a debridement of dead bone, take out the pus, and make a buccal pad. The acute pain was there for three days, but now, after a month of surgery, I still feel some pain.

Some days I have very little pain, and other days medium pain. But no pain medication works for me. I was at an ENT specialist, and they made a CT scan of my sinuses, and the result of my sinuses is 100 % healthy. They also took a blood test, and everything was fine in the reports. Is it normal to feel pain after this type of surgery for his long?

Please help me.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

The pain had not subsided yet, right? I will be prescribing you accordingly.

Thanks and regards.

Answer 2

Hello,

Welcome back to icliniq.com.

Such things happen as post-operative complications for a long time, only in extensive cases where bone debridement was done. My questions are:

What exactly is the kind of pain you are feeling, like radiating, throbbing, or pulsing pain from that segment?
Do you take any painkillers when such pain repeats?

Please revert with your answers.

Answer 3

Hello,

Welcome back to icliniq.com.

I have opened the link and examined it (attachments removed to protect the patient’s identity). See, there is so much physical stress, tension, and trauma to the bone during debridement and surgery that the healing bone should take several months to form afresh again.

And the sinus, as we know, is pneumatized, meaning it is a hollow, expandable space that is not exactly solid. So what I am trying to say is that in extensive surgeries, you really need to have a lot of patience post such bone debridement and fistula tract removal surgeries because the healing bone and soft tissue formed should be much stronger.

For that, you will need to take vitamin supplements, vitamin C, and vitamin E every day after breakfast for 10 days at least a month. Neurobion forte (Riboflavin, Pyridoxine hydrochloride, Nicotinamide, cyanocobalamin, Calcium pantothenate, and Thiamine mononitrate) tablet. Vitamin K-rich foods should be consumed in your diet if you are not on any medications.

Oral hygiene should be very strict with chlorhexidine gluconate twice a day and with topical vitamin E, even a 400 mg application to the gums over the surgical part as well. So all these remedies will reinforce strong bones over a period of time, and eventually, you will start seeing some pain relief.

Though, as I said, such post-operative dull pain is uncommon, it is important to remember that surgical excision usually leads to scar formation sometimes. So in such extensive surgeries like the removal of an oroantral communication, healing will definitely take a lot of time.

If the pain still persists after trying a month or two, even after these remedies, then certainly you have to visit the oral surgeon in the clinic. An antiseptic irrigation or local antibiotic prophylaxis by your oral surgeon in the clinic might help as a last resort in persistent pain. Take the medications after consulting your specialist doctor.

I hope this helps.

Thanks and regards.

Answer 4

Hi,

Welcome back to icliniq.com.

I think it is time for you to consult the surgeon at the clinic. Yes, it will usually be decipherable in a CT (computed tomography) scan, but I need to see some pictures.

Maybe you would enclose them afresh now, so I know exactly how the healing is and whether there is a risk of poor healing or osteoid issues that are causing pain?

Thanks and regards.

Answer 5

Hi,

Welcome back to icliniq.com.

Yes, maybe you would reconfirm by clearing your doubts through another CBCT (cone-beam computed tomography) scan and then send me the reports for a second opinion. Do not worry, postoperative pain may be very stressful, but it is a reality.

I guess that as long as you are on proper vitamins that will heal your nerves, I feel you should not worry too much about it. Go for a CBCT if you seek reassurance of the same, but if the pain persists past another 15 to 20 days.

I think it is wise to get it done either way, so I can assess it.

Take care.

Thanks and regards.