Short summary / likely scenario

• A 7-year-old male with an ectopically erupting/extruded permanent tooth (FDI 21) that presented in or near the nasal cavity/vestibule and was extracted.

• Photo shows the nostril/oral vestibule area with the extraction site and adjacent mucosa — looks like soft-tissue involvement of the nose/nasal floor region rather than a simple intraoral socket alone.

• Because this involves the nasal mucosa / floor of nose, management and follow-up should consider both dental and ENT issues.

 Examination (based on the photo + history)

• Local soft tissue defect/laceration near the nasal vestibule — extraction site appears fresh.

• No active heavy bleeding visible in photo (good). Mild blood clot/serous exudate likely present.

• Possible communication risk between oral cavity and nasal floor depending on defect depth — needs direct clinical check.

• Age 7: root development of permanent central incisor may be incomplete — consider risk to adjacent developing tooth buds.

 Healing timeline & what to expect

Day 0–3 (immediate):

• Clot formation, soft tissue swelling, mild nasal discomfort. Minimal serosanguinous discharge possible.

• Patient should avoid nose blowing, vigorous sneezing, and digital trauma.

Day 4–14 (first two weeks — critical):

• Soft tissue epithelialization begins; reduction in swelling and pain.

• Sutures (if placed) typically removed at 7–10 days. By day 14 most soft tissue should look significantly healed though mucosa may still be fragile.

1–3 months:

• Deeper soft tissue maturation and bone apposition. Monitor for persistent fistula or sinus symptoms.

3–6 months+:

• Full remodelling of alveolus and confirmation that no chronic nasal communication or infection persists.

 Post-op care / process to execute (practical steps)

1. Immediate care (first 48–72 hrs):

   • Apply gentle external pressure if bleeding; avoid nose blowing.

   • Cold compress intermittently for first 24 hrs for swelling.

   • Soft diet; avoid inserting anything into nostril.

2. Medications (as indicated by clinician):

   • Analgesics (paracetamol/ibuprofen per paediatric dosing).

   • Consider short course of systemic antibiotics if contamination, large mucosal tear, or ENT/dental surgeon prescribes (amoxicillin ± clavulanate or per local guidelines).

   • Nasal saline sprays to keep mucosa moist (once bleeding controlled).

3. Wound care & behaviour:

   • No nose blowing for 7–14 days; sneeze with mouth open.

   • Keep child from rubbing/picking the area.

4. Follow-up:

   • 24–72 hr check (to ensure hemostasis and assess early infection).

   • 7–10 day suture check/remove.

   • 2-week and 1-month review to confirm epithelialization and screen for oro-nasal fistula.

   • ENT referral if any nasal obstruction, unilateral nasal discharge, or signs of sinus involvement.

5. Radiographic follow-up:

   • Periapical/panoramic radiograph or CBCT if retained fragments / concern for adjacent developing tooth bud.

 If healing is only 14 days — potential issues that can scale up

(If the site still problematic at day 14, be alert for:)

• Persistent oro-nasal communication (fistula) → chronic nasal regurgitation, speech issues, recurrent infection.

• Infection / sinusitis (unilateral purulent nasal discharge, fever) → needs antibiotics/ENT drainage if severe.

• Delayed soft tissue closure → may require secondary surgical closure (local flaps).

• Pulpal / developmental damage to adjacent developing permanent teeth → arrested root development, discoloration, or need for future endodontic/orthodontic care.

• Retained root fragment → persistent inflammation or sinus tract requiring removal.

• Psychological/behavioural issues — children may pick at site; increases risk for failure.

 Red flags — seek immediate re-evaluation if any of these occur

• Increasing pain, swelling, fever.

• Continuous or worsening nasal discharge (especially purulent or foul-smelling).

• Persistent bleeding not controlled by simple measures.

• Difficulty breathing or severe nasal obstruction.

• Signs of oral–nasal regurgitation of liquids.

 Comments / clinical recommendations

• Because this involves the nasal mucosa, a joint dental + ENT review is recommended early — even if first 14 days appear uneventful — to confirm no sinus communication and to protect developing dentition.

• Prophylactic antibiotics are not mandatory for every case but are commonly used when extraction site breaches the nasal floor or in contaminated wounds — follow your local surgical protocol.

• Document healing with photos at baseline, 7 days, and 14 days; obtain radiograph if any persistent symptoms.

• Educate parents about the importance of preventing nose-picking/blowing.

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