Maxillary Antral Lavage – Sinus Washout
When I was an ENT trainee, the Antral lavage followed by systemic antibiotic was very common form of treatment in acute sinusitis. At times the Sinus washout was repeated every week till patient returned to normality. Some how the hype in FESS surgery, this old fashioned minor procedures were ignored and it is time to revisit the good old time tested minor procedure once again for the sake of patient.
Definitions:
Irrigation of the maxillary sinus through its natural ostium or through a puncture of the inferior meatus under local infiltration and surface anesthesia-Lidocaine.
Introduction:
The cheek bone or maxilla is hollow. This keeps the bones of the face nice and light. The space inside any face bone is called a sinus. The sinus in the maxilla is sometimes called the antrum and is very large. The bone between the sinus and the inside of the nose is thin like an egg shell. The sinus in the cheek bone has a little drain hole which leads into the upper part of the inside of your nose. Normally the hole lets in air. Infection may drain from the sinus into your nose…..
Diagnosis
Examination of Nasal passage-Rhinoscopy
Nasal Endoscopy
CT Scan Sinus
The Procedure
Maxillary Antral lavage involves piercing the wall between the nose and maxillary sinus with an Antral lavage needle and rinsing out the pus in the sinus cavity with fluid; the tiny hole heals quickly.
I use local anesthetic lidocaine spray and infiltrate the inferior meatus with a drop of lidocaine 4% using a fine needle.
A fine metal tube-Trocar and Canula- will be pushed into the nose and through the thin bone of the maxilla into the sinus. Salty water will be flushed through the tube into the sinus. The salty water will come out of the little drain hole in the sinus, and drain into the nose…..
Possible surgical complications of Maxillary antral lavage is rare, may include: pain, and numbness of upper teeth for few minutes. Rarly little blood stained discharge.
Post operative care
A course of broad spectrum antibiotic, Nasal decongestant drops, Antihistamines and Pain killers(if needed) should be given for a week. If any pus obtained it should be sent for Culture and see the result and give appropriate antibiotic.
