Note: This procedure is different than balloon sinuplasty of the maxillary sinus ostium which is a very commonly performed procedure now and may be preferable to an antrostomy.
Also known as: endoscopic middle meatal maxillary antrostomy, middle meatal antrostomy
Diagnosing Chronic Sinusitis
Prior to undergoing sinus surgery, your healthcare provider will want to confirm chronic sinusitis with a CT scan. X-rays are not as often desired, as they can only show sinus disease and less specific information regarding other nasal sinus issues. The CT scan not only will show the severity of maxillary sinus inflammation but will also provide your healthcare provider with this other important information:
Position of the nasolacrimal ductUncinate process — which is an important part of the surgical processThickening of the mucus membranesAir versus fluid levels in the sinus cavitiesPolypsOsteomeatal complex obstruction — prevents drainage of the maxillary sinus
While this is a lot of technical medical terminology, all this information will provide your healthcare provider with the information needed to be properly prepared for your surgical procedure. The osteomeatal complex is made up of the following four nasal structures:
Uncinate process — is an L-shaped bone that will be removedmaxillary ostium (opening of the maxillary sinus)infundibulum — curved channel in the noseethmoid bulla — one of the ethmoid sinuses
Preparation for Endoscopic Sinus Surgery and Maxillary Antrostomy
Prior to surgery, you will have been instructed to have nothing to eat or drink from midnight the day of surgery until after the surgery is performed. This will help prevent your risk of inhaling stomach contents (aspiration). In the pre op area, you will most likely be given Afrin nasal spray to decongest your nasal passages to help increase the area of visibility during your surgery. Once anesthetized, you may also have gauze soaked in Afrin or topical cocaine used in your nose to further enhance visibility if necessary.
Goals
There are 3 main goals that your healthcare provider will try to accomplish during a maxillary Antrostomy
Remove the uncinate processFinding the natural opening into the maxillary sinusEnlarging the opening into the maxillary sinusRemove polyps from within the maxillary sinus cavity
It is important that your healthcare provider remove the uncinate process at the beginning of the procedure in order to better visualize the maxillary sinus opening. If the sinus opening is not located and a new opening is created, you can have recycling of sinus drainage, where drainage exits one opening and reenters the sinus cavity through the other opening.
After a Maxillary Antrostomy
After your surgery is complete, you will wake up in the post-anesthesia care unit (PACU). There you will be monitored for bleeding, nausea (which can occur if blood is swallowed), or other potential complications from the surgery. You will then follow-up with your healthcare provider between 3 and 5 days to have your nasal packing removed. Depending on the success and if you have any remaining symptoms will determine what further medical interventions are tried after surgery.
Risks
Aside from normal risks associated with any surgery requiring general anesthesia, maxillary antrostomy also has the following risk factors:
Injury to the area around the eye (orbital injury) Blindness Nasolacrimal duct injury Nosebleed (epistaxis) Cerebrospinal fluid (CSF) rhinorrhea Meningitis
Aside from a nosebleed, most of the previously listed risk factors are quite rare. Maxillary antrostomy is a common procedure, however, these are the associated risk factors. Many of these factors are in relation to surgical instruments used like the microdebrider, which is also generally safe and has relatively few complications. However the risk factors listed above are severe albeit rare, so please always choose a skilled ENT to perform the procedure.
