Post nasal drip after bone graft and implant surgery: cause and treatment?

I recently placed 2 implants in sites #8, 7 [maxillary right central incisor and lateral incisor; 11, 12] on my sister in law. When I took a post-op radiograph, everything looked fine. Then I wanted to place an implant on the upper left molar but since the bone was insufficient as I only had 3mm width of bone, I opted to do a bone split and place a graft material to augment the bone. That evening, she mentioned that she was having nasal drip on her left side of the nose that was opposite from where I had installed the implants. On the radiograph, tooth number #9 [maxillary left central incisor; 21] had a radiolucent lesion but I did not treat that tooth at that visit. Now, my question is, what caused the post nasal drip if I did not touch the side where the secretion is accumulating. She said it was just faint but whenever she sniffed, there was a little discomfort. So, I asked her to take a decongestant and Augmentin just to start and prevent whatever is happening. When I asked her if there were particles coming out maybe coming from the lateral sinus, she said there were none. Can you please help me identify the cause? I am a bit worried because she is my sister-in-law. We only did the surgery today Feb 17, 2015.

12 Comments on Post nasal drip after bone graft and implant surgery: cause and treatment?

New comments are currently closed for this post.

CRS

2/24/2015

It is probably unrelated. The decongestant is fine, but the antibiotic is not a first line choice in the absence of a full blown sinusitis. I like to save augmentin for oral administration after iv unasyn in fascial space infections. How much bone height was there in the augmented area, do you think you perforated the sinus floor? Did you charge her the family rate?ðŸ˜Š

Armi

2/24/2015

Dear CRS, Thank you for your response. Yes. On the radiograph, the area where I grafted the bone was at least 3mm short from the sinus. So far after a week, everything looks fine and the nasal drip was gone. I was advised though not to place the implant on the molar area because of her sinusitis. She just revealed to me a day after that she has sinusitis and it may have triggered it after the surgery. What do you think of that? And yes, I did charge her a relative rate only. I guess I am still bound by my ethics, no pun intended. :)

CRS

2/24/2015

My family rate is double!!

amica

2/24/2015

I don't have the heart to charge her double. :))) My husband restrained me from doing so. Besides, I just think of her as my walking advertisement. As soon as things are in place, then maybe more people will come to me.

Barrow Marks

2/24/2015

The post nasal drip is unrelated to the implant surgery. However, your procedure in the molar area is possibly the causative factor. The maxillary sinus is lined with cilia that are responsible for moving debris from the sinus to the nasal mucosa. Your local anesthetic in this area can create a situation where the cilia cannot do their job temporarily . You were correct to administer a decongestant and antibiotic . Your choice of augmentin was excellent . The problem will soon clear up and you will still be the family hero even if you cannot pay your student loan. Good luck. Barrow

CRS

2/25/2015

As I said before it is unrelated to the surgery.

amica

2/24/2015

Thank you Dr Barrow Marks. Your advise is like the premonition of what already happened. True enough the nasal drip dried up as soon as I had her on decongestants and antibiotics and my sister in law was back to normal. However, since she has sinusitis, I was advised by my colleague not to place the implants on the grafted site. Instead, I was told to seek for the opinion of the ENT before we proceed with the implant. What can you advise me on this? Because she is expecting that I place one more implant on that site.

Dr Bob

2/25/2015

Perhaps you should evaluate and treat, if needed, the area on the #9 as this may expand and cause a problem with the adjacent implant. Did you do a CBCT to evaluate the quantity of bone in the molar area? Just curious as to how you measured the bone. Often maxillary bone can be expanded and implant placement done without grafting. Also two narrow implants are sometimes an option to avoid grafting instead of placing one larger diameter implant. An ENT consult can do no harm. What does her GP say about this sinus problem?

Frank Scarbrough

2/25/2015

Send her to an OMFS for a CBCT evaluation of the sinus. Let the OMFS try to optimize sinus health with meds, prior to implant placement. If sinusitis is chronic, then send her to ENT for FESS, if OMFS doesn't do that procedure.

Payman

2/26/2015

Hi, You did split bone expansion, most probably you have torn the membrane. Don't you think?

amica

2/26/2015

On the post op image, I was 3mm short from the sinus membrane. A week after the patient was in good shape again.

CRS

2/26/2015

With the procedure you described it should be fine. Let the bone heal, go back and place the implants. Where dentists get into trouble is when the ostealmeatal opening gets blocked during aggressive sinus lifts or perforations with extravasation of graft material. This sounds like a simple post nasal drip which is unrelated to the surgery since you were 3mm below the sinus floor. Don't panic give it time to heal and place the implants. An acute sinusitis has more severe symptoms such as purulent discharge, headache, pain upon leaning forward and fever. In six weeks if you caused an o-a communication you'll see it since the wound will open up. No harm if the patient wants to see an ENT but he'll probably just put her on Flonase. I would just watch it heal and avoid her on the family holidaysðŸŽ‰