I had an upper left molar tooth extracted last month; I suspect my cribriform plate was broken, can this cause Anosmia?

Question:

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). I was visibly swollen, after the lidocaine wore off, I had a debilitating head ache (only left side) for many days and on two consecutive mornings after the extraction, a very watery yellowish liquid suddenly ran through my left nostril, when I bent my head forward. On the second occasion, I collected it on a paper and it formed a pinkish center with a yellow ring around it. The handkerchief did not stiffen, and I have a serious suspicion the leak might have been a sudden CSF leak (CSF Rhinorrhea) due to the blunt trauma on my head.

I suspect my cribriform plate was broken, as I had a very sharp pain in the whole bony area around my nose and left eye for many days. I also lost my sense of smell in my left nostril after the sinus perforation and tooth extraction. My sense of smell was perfect before, if not even too much sharp. Nowhere I could find corroboration on the fact that Anosmia can be caused by sinus perforation – something which my dentist claims is normal. On the contrary, I found many scientific reviews which state that Anosmia can be due to damage of the olfactory nerve and after a CSF leak through the eustachian tube, caused by fracture of the cribriform plate or petrous bone (if the fistula is in the middle ear). I also had  very strong headache on the left temporal bone, just above the ear…

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, however, and not a CSF leak which may have resorted on its own after several days.

Thank you very much for reading this.
I appreciate your time and help!

Kind Regards,

Answer:

Hi!

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 to 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 (cribriform 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 smell will return.

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.

I would be happy to see you here at the NY Sinus Center to help as above.  We have significant experience with these issues.

Robert Pincus MD
Associate Professor Otolaryngology NY Medical College
Co-Director  NY Sinus Center

 

 

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