“The longer you look back, the further you can look”
Antral Lavage still not out
Nasal irrigation had been practiced from the time of the great Indian plastic surgeon Sushrutha, 600BC. Modern Irrigation of the maxillary sinus through a puncture of the inferior meatus is being performed from ninetieth century.
Using Lichtwitz trocar and cannula, a puncture is made in the genu-middle of the inferior meatus, after applying local anesthetic, in the form of spray, ointment and infiltration.
Infiltration of the inferior meatus with 4%Xylocaine and adrenaline, using a dental syringe was described by me in 1989.It turned to be very effective, in countries where cocaine paste or solution was not available.
Since the advent of modern Endoscopes and instruments, this time tested simple procedure of antral lavage became less popular. But recent studies showing the increasing number of relapses/failures of the modern Endoscopic procedures, a look back into this old procedure is worth considering.
In acute sinusitis with throbbing headache, an antral wash out followed by medical treatment is still the best option. In chronic sinusitis also, repeated antral lavage is worth considering.
The advantages of this procedure, it can be done under Local anesthesia in the OPD clinic, no need for general anesthesia, no hospitalization, hence very cost effective to the patient.
CT scan Acute sinusitis
Ref to my article from JLO 1989 below-
Maxillary antral lavageâ€”infiltration and surface anesthesia compared
K. O. Paulosea1 c1, S. Al Khalifaa1, P. Shenoya1 and R. K. Sharmaa1
a1 Department of ENT. Bahrain Defence Force Hospital. Bahrain.
A prospective study on 210 patients was conducted to determine the relative efficacy of infiltration anesthesia as against surface anesthesia for antral lavage. The patients were categorized into three groups and comparisons were made on patient response and our observations. This study confirms that infiltration technique is superior to surface anesthesia and is, also, less time consuming.
(Accepted January 10 1989)
c1 Mr. K. O. Paulose, F.R.C.S., P. O. Box 29132, East Riffa, State of Bahrain.
The Journal of Laryngology & Otology (1989), 103:582-584 Cambridge University Press