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Upper teeth near the back of the upper jaw are usually very close to the maxillary sinuses, which are air-filled cavities beneath your eyes and behind your cheekbones. A frequent complication of removing upper molar (back) teeth is exposure of the sinus floor. Most exposures will heal spontaneously or with minimal intervention as long as the following instructions are strictly adhered to after the surgery:

• Some intermittent nose bleeding from the side of the surgery is a normal occurrence. Please do not be alarmed.

• Do NOT blow your nose vigorously for two weeks. There is a natural communication between your nose and sinus. Any positive pressure in your nose will be directly transferred to the sinus and subsequently to the fresh extraction site. If you feel "stuffed up", decongestants such as Drixoral, Dimetapp, or Sudafed will help reduce pressure in the sinuses.

• Please keep your tongue away from the fresh surgical site. As the swelling subsides, the stitches might feel like they are loosening up. Please do not cut them prematurely.

• Do NOT use straws for two weeks. The negative pressure generated from the straw will lead to breakdown of the fresh extraction site.

• Do NOT smoke for two to three weeks. Smoking has a much more profound effect on oral wounds than it does on any other part of the body, since the effect of the smoke is in direct contact with the healing wound. Wound breakdown and poor healing are ten times more prevalent in smokers than in nonsmokers.

• When sneezing, please do so with your mouth open, and do not sneeze holding your nose. The generated pressure must be released without transmitting to your sinuses.

• Anything that causes pressure in your nasal cavity must be avoided. Avoid "bearing down"—as when lifting heavy objects, blowing up balloons, playing musical instruments that require a blowing action or any other activity that increases nasal or oral pressure. Scuba diving and flying in pressurized aircraft may also increase sinus pressure and should be avoided.

Failure to adhere to these instructions could result in a permanent communication (fistula) between your mouth and your sinus. This would require an additional highly invasive surgery that would incur further cost and recovery time. Prevention is always the most prudent option.


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