Antral lavage is a surgical procedure in which a cannula is inserted into the opening of the maxillary sinus via the inferior meatus to allow irrigation and drainage of the sinus. It is also called proof puncture as the presence of an infection can be proven during the procedure. Upon presence of infection, it can be considered as therapeutic puncture.
Contents
Medical uses
It can be used as therapeutic procedure for:
It can be also used as diagnostic procedure for:
Contraindications
Age: Below the age of 3 years, as the size of the sinus is small due to underdeveloped Maxillary Sinus.
Bleeding disorders: May lead to epistaxis.
Fracture of maxilla: Antral Lavage may result in escape of the fluid through fracture lines.
Febrile stage of acute maxillary sinusitis: May cause osteomyelitis of Maxilla.
Procedure is contraindicated in diabetic and hypertensive patients.
Acute maxillary sinusitis not resolving on medical treatment.
Instruments
The following instruments are used in the procedure:
Diagnosis of antral pathology
- Watery, amber color fluid flowing from cannula, immediately on puncture and containing cholesterol crystals, indicates presence of cyst.
- Blobs of mucopus in washings indicates hyperplastic sinusitis.
- Presence of frank, foul-smelling pus, which easily mixes with irrigating fluid indicates suppuration and in such cases, antral wash may be repeated once or twice a week.
- Plain Radiological X-rays (Water's view) of sinuses is most specific non- invasive method of diagnosing Antral pathology.
Difficulties
The following difficulties may arise during antral lavage:
Complications
- Vasovagal shock: Due to over stimulation of the vagus nerve, the patient may become pale, may faint and fall down and the pulse rate may decrease.
- Bleeding may occur at the site of the puncture which stops in a short time with cotton wool plug.
- False passages into cheek or orbit leading to emphysema or extravasation of fluid into the cheek or lower eyelid or orbit. Also may lead to cerebrospinal fluid leak and haematoma.
- Infection in the maxillary sinus is common.
- Anaesthetic complications may occur.
- Air embolism.
Repetition
If the returning fluid is purulent, one repeats the puncture after a week. If more than three successive puncture shows returning fluid to be persistently purulent, the patient may require functional endoscopic sinus surgery (FESS) and occasionally may need Caldwell-Luc operation.
As antral Washout is a much simpler procedure compared to FESS, it may be done on an outpatient basis for Subacute Maxillary Sinusitis. However, FESS remains gold standard in treatment of Chronic Maxillary Sinusitis.
Post operative
- Patient lies down for 10–15 minutes after operation and pack is removed after an hour.
- Antibiotic should be given for 5–6 days in cases of suppuration depending upon culture and sensitivity.
- Oral and local decongestant are given to improve the patency of ostium.
- Analgesics may be required for post-operative headache.