Question: Hello, I have been experiencing sinus problems after undergoing jaw surgery last year. I had a Lefort 3 procedure for temporomandibular joint dysfunction (TMJ) and a maligned jaw in October 2014. Almost immediately after surgery, I felt a tract from my nose running into my cheek, and my cheek on that side of my face was definitely more swollen. Then I developed a case of sinusitis and have been on numerous courses of antibiotics since then, with little or no relief. Due to my post-surgery issues, I have seen 2 ENT surgeons to get some answers and help, as I need relief from this. I had two endoscopy sinus biopsies done and both came back negative. After everything, I now have pressure and pain on my nasal bridge. I still just don’t feel well and have been experiencing sinus headaches.
Can you suggest anything? Even possibly consider a second opinion? I have had an endodontist visit to check out my root canals and they came back fine. I also have had two CT scans done, and they both were apparently negative. Please help me!
Answer:
Unfortunately, it is difficult to give you a definitive answer to why this has happened without performing an in-person evaluation and looking at your medical history. However, complications and sinus problems after jaw surgery, such as sinusitis, can occur. But the answer as to why this happens also varies on the individual and the variables at hand. I would suggest another ENT and possibly get an OMFS consultation/opinion. If you are in the New York City area I suggest seeing Dr. Robert Pincus or myself (Dr. Scott Gold) at our practice. If you are not in the New York area we might be able to suggest an expert closer to you.
Hope this clears things up!
Scott Gold, MD
The New York Otolaryngology Group
Frequently Asked Questions
Sinus problems after jaw surgery, such as the Lefort 3 procedure, can include sinusitis, persistent sinus infections, swelling, pain, and the formation of abnormal tracts between the nasal cavity and facial tissues. These complications vary by individual and may arise due to surgical impact on the sinus anatomy.
Persistent sinusitis after jaw surgery may not always respond to antibiotics if the underlying cause is related to anatomical changes, surgical complications, or non-infectious inflammation. These cases often require further diagnostic evaluation to identify structural issues or fistulas that antibiotics cannot resolve.
Common diagnostic tests for sinus problems post-jaw surgery include CT scans to evaluate sinus anatomy, endoscopy to visually inspect sinus and nasal tissues, and biopsy in some cases to rule out infection or other pathological causes. Despite normal test results, symptoms may persist due to surgical changes.
A second opinion is advisable if sinus symptoms persist despite treatment, if diagnostic tests are inconclusive, or if quality of life is affected. Consulting both an ENT specialist and an oral and maxillofacial surgeon (OMFS) can provide comprehensive evaluation and care.
Yes, both otolaryngologists (ENT specialists) and oral and maxillofacial surgeons (OMFS) are experts who manage sinus complications related to jaw surgery. Collaboration between these specialties helps ensure accurate diagnosis and effective treatment plans.
If imaging and biopsies are negative but symptoms persist, further specialized evaluation may be required to assess for subtle anatomical changes, mucosal inflammation, or fistulas. Treatment may include targeted therapies, surgical revision, or symptom management strategies tailored to the individual.
