Specialist ENT ANTRAL PUNCTURE

ANTRAL PUNCTURE

Definition: It is a procedure done both for diagnosis and treatment of sinusitis, where a canula is inserted into the maxillary sinus via an opening made in the inferior meatus. It was widely practiced before FESS surgery.

Specialist ENT Screenshot 2020 11 27 Ganpati nose
Indications:
Therapeutic: Antral Lavage:
(a) It is done in cases of chronic maxillary sinusitis, not responding to conservative medication.
(b) This procedure can also be done for instillation of medication and irrigation in cases of atrophic rhinitis.

Diagnostic: 1. Proof puncture: Radiological appearances of sinusitis is confirmed by a puncture.
2. The washing can be sent for pus, smear culture, antibiotic sensitivity and cytological examination.
Contraindications:
  1. Not done in children below 3 years of age due to proximity of the orbital floor and teeth in small maxillary sinus.
  2. Acute sinusitis.
  3. Traumatic conditions damaging orbital floor and maxilla.
  4. Hypertension, diabetes mellitus.
Anesthesia: It is usually done under local anesthesia but can be done under general anesthesia.
The 3 main nerves blocked by local anesthesia are:
  1. Superior alveolar nerve near the inferior meatus.
  2. Anterior ethmoidal nerve near the roof of the nose.
  3. Posteriorly the sphenopalatine ganglion.
Puncture sides: The Tilley- Lichtwitz trocar and cannula is passed under the attachment of the inferior turbinate up-to the genu pointing to the homolateral ear. Procedure: A Higginson’s syringe with sterile or normal water at 37 Degree Celsius is attached to cannula and the maxillary sinus is flushed.
Specialist ENT Screenshot 2020 11 27 Ganpati nose
Three successive flushed of clear saline water are required. Dilute potassium permanganate or povidone iodine washes can also be given. Complications:
  1. Bleeding: This occur from local blood vessels.
  2. Orbital damage: Perforation of the orbital floor causing proptosis and pain.
  3. 3. Cheek swelling: Breaching of soft tissue of the cheek and anterior wall.
  4. Air embolism due to injury to veins.
  5. Infection of maxillary sinus.
  6. Vasovagal Shock.
  7. Anesthesia complications.

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