Antral lavage

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Antral lavage
Specialty Otorhinolaryngology

Antral lavage is a largely obsolete[ citation needed ] surgical procedure in which a cannula is inserted into the maxillary sinus via the inferior meatus to allow irrigation and drainage of the sinus. [1] 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. [2] Often, multiple repeated lavages are subsequently required to allow for full washout of infection.

Contents

In contemporary practice, endoscopic sinus surgery has largely replaced antral lavage and as such, it is rarely performed.

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. [10]

Bleeding disorders: May lead to epistaxis. [10]

Fracture of maxilla: Antral Lavage may result in escape of the fluid through fracture lines. [10]

Febrile stage of acute maxillary sinusitis: May cause osteomyelitis of Maxilla. [10]

Procedure is contraindicated in diabetic and hypertensive patients.

Acute maxillary sinusitis not resolving on medical treatment. [1]

Instruments

The following instruments are used in the procedure: [11]

Diagnosis of antral pathology

  1. Watery, amber color fluid flowing from cannula, immediately on puncture and containing cholesterol crystals, indicates presence of cyst. [4]
  2. Blobs of mucopus in washings indicates hyperplastic sinusitis. [9]
  3. 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. [12]
  4. Plain Radiological X-rays (Water's view) of sinuses is most specific non- invasive method of diagnosing Antral pathology. [13]

Difficulties

The following difficulties may arise during antral lavage: [4]

Complications

  1. 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. [1]
  2. Bleeding may occur at the site of the puncture which stops in a short time with cotton wool plug. [1]
  3. 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. [14]
  4. Infection in the maxillary sinus is common. [4]
  5. Anaesthetic complications may occur. [4]
  6. Air embolism. [15]

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. [4]

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. [16]

Post operative

  1. Patient lies down for 10–15 minutes after operation and pack is removed after an hour.
  2. Antibiotic should be given for 5–6 days in cases of suppuration depending upon culture and sensitivity. [17]
  3. Oral and local decongestant are given to improve the patency of ostium. [18]
  4. Analgesics may be required for post-operative headache. [9]

Newer techniques

1) Discovery of the location of the Maxillary Sinus with greater accuracy.
2) A general improvement in safety of the procedure.
3) The ability to obtain cultures at the time of lavage, when clinically warranted or indicated by CT-scan evidence.
4) Avoiding the need for exposure to radiation, as fluorescence is used in its stead.
5) Lack of interference in anatomy.

Related Research Articles

<span class="mw-page-title-main">Sinusitis</span> Inflammation of the mucous membrane that lines the sinuses resulting in symptoms

Sinusitis, also known as rhinosinusitis, is inflammation of the mucous membranes that line the sinuses resulting in symptoms that may include thick nasal mucus, a plugged nose, and facial pain. Other signs and symptoms may include fever, headaches, a poor sense of smell, sore throat, a feeling that phlegm is oozing out from the back of the nose to the throat along with a necessity to clear the throat frequently and frequent attacks of cough.

<span class="mw-page-title-main">Nasal polyp</span> Noncancerous growths within the nose or sinuses

Nasal polyps (NP) are noncancerous growths within the nose or sinuses. Symptoms include trouble breathing through the nose, loss of smell, decreased taste, post nasal drip, and a runny nose. The growths are sac-like, movable, and nontender, though face pain may occasionally occur. They typically occur in both nostrils in those who are affected. Complications may include sinusitis and broadening of the nose.

<span class="mw-page-title-main">Nasal irrigation</span> Personal hygiene practice for rinsing out nasal passages

Nasal irrigation is a personal hygiene practice in which the nasal cavity is washed to flush out mucus and debris from the nose and sinuses, in order to enhance nasal breathing. Nasal irrigation can also refer to the use of saline nasal spray or nebulizers to moisten the mucous membranes.

<span class="mw-page-title-main">Post-nasal drip</span> Medical condition

Post-nasal drip (PND), also known as upper airway cough syndrome (UACS), occurs when excessive mucus is produced by the nasal mucosa. The excess mucus accumulates in the back of the nose, and eventually in the throat once it drips down the back of the throat. It can be caused by rhinitis, sinusitis, gastroesophageal reflux disease (GERD), or by a disorder of swallowing. Other causes can be allergy, cold, flu, and side effects from medications.

<span class="mw-page-title-main">Aerosinusitis</span> Barotrauma of the sinuses

Aerosinusitis, also called barosinusitis, sinus squeeze or sinus barotrauma is a painful inflammation and sometimes bleeding of the membrane of the paranasal sinus cavities, normally the frontal sinus. It is caused by a difference in air pressures inside and outside the cavities.

<span class="mw-page-title-main">Maxillary sinus</span> Largest of the paranasal sinuses, and drains into the middle meatus of the nose

The pyramid-shaped maxillary sinus is the largest of the paranasal sinuses, located in the maxilla. It drains into the middle meatus of the nose through the semilunar hiatus. It is located to the side of the nasal cavity, and below the orbit.

Balloon sinuplasty is a procedure that ear, nose and throat surgeons may use for the treatment of blocked sinuses. Patients diagnosed with sinusitis but not responding to medications may be candidates for sinus surgery. Balloon technology was initially cleared by the U.S. Food and Drug Administration in 2005 and is an endoscopic, catheter-based system for chronic sinusitis. It uses a balloon over a wire catheter to dilate sinus passageways. The balloon is inflated with the goal of dilating the sinus openings, widening the walls of the sinus passageway and restoring normal drainage.

Silent sinus syndrome is a spontaneous, asymptomatic collapse of an air sinus associated with negative sinus pressures. It can cause painless facial asymmetry, diplopia and enophthalmos. Diagnosis is suspected based on symptoms, and can be confirmed using a CT scan. Treatment is surgical involving making an outlet for mucous drainage from the obstructed sinus, and, in some cases, paired with reconstruction of the orbital floor. It is slightly more common in middle age.

Chronic atrophic rhinitis, or simply atrophic rhinitis, is a chronic inflammation of the nose characterised by atrophy of nasal mucosa, including the glands, turbinate bones and the nerve elements supplying the nose. Chronic atrophic rhinitis may be primary and secondary. Special forms of chronic atrophic rhinitis are rhinitis sicca anterior and ozaena. It can also be described as the empty nose syndrome.

<span class="mw-page-title-main">Functional endoscopic sinus surgery</span> Surgery to enlarge the paranasal sinus drainage pathways

Functional endoscopic sinus surgery (FESS) is a procedure that is used to treat sinusitis and other conditions that affect the sinuses. Sinusitis is an inflammation of the sinuses that can cause symptoms such as congestion, headaches, and difficulty breathing through the nose.

Rhinosinusitis is a simultaneous infection of the nasal mucosa (rhinitis) and an infection of the mucosa of the paranasal sinuses (sinusitis). A distinction is made between acute rhinosinusitis and chronic rhinosinusitis.

A sinus is a sac or cavity in any organ or tissue, or an abnormal cavity or passage caused by the destruction of tissue. In common usage, "sinus" usually refers to the paranasal sinuses, which are air cavities in the cranial bones, especially those near the nose and connecting to it. Most individuals have four paired cavities located in the cranial bone or skull.

<span class="mw-page-title-main">Odontogenic infection</span> Infection originating in a tooth

An odontogenic infection is an infection that originates within a tooth or in the closely surrounding tissues. The term is derived from odonto- and -genic. The most common causes for odontogenic infection to be established are dental caries, deep fillings, failed root canal treatments, periodontal disease, and pericoronitis. Odontogenic infection starts as localised infection and may remain localised to the region where it started, or spread into adjacent or distant areas.

<span class="mw-page-title-main">Nasolacrimal duct obstruction</span> Medical condition

Nasolacrimal duct obstruction is the obstruction of the nasolacrimal duct and may be either congenital or acquired. Obstruction of the nasolacrimal duct leads to the excess overflow of tears called epiphora.

<span class="mw-page-title-main">Sinus implant</span>

A Sinus implant is a medical device that is inserted into the sinus cavity. Implants can be in conjunction with sinus surgery to treat chronic sinusitis and also in sinus augmentation to increase bone structure for placement of dental implants.

Caldwell-Luc surgery, Caldwell-Luc operation, also known as Caldwell-Luc antrostomy, and Radical antrostomy, is an operation to remove irreversibly damaged mucosa of the maxillary sinus. It is done when maxillary sinusitis is not cured by medication or other non-invasive technique. The approach is mainly from the anterior wall of the maxilla bone. It was introduced by George Caldwell (1893)and Henry Luc (1897). The maxillary sinus is entered from two separate openings, one in the canine fossa to gain access to the antrum and other in the naso antral wall for drainage.

<span class="mw-page-title-main">Fungal sinusitis</span> Inflammation of the paranasal sinuses due to fungal infection

Fungal sinusitis or fungal rhinosinusitis is the inflammation of the lining mucosa of the paranasal sinuses due to a fungal infection. It occurs in people with reduced immunity. The maxillary sinus is the most commonly involved. Fungi responsible for fungal sinusitis are Aspergillus fumigatus (90%), Aspergillus flavus, and Aspergillus niger. Fungal sinusitis occurs most commonly in middle-aged populations. Diabetes mellitus is the most common risk factor involved.

<span class="mw-page-title-main">Oroantral fistula</span> Medical condition

Oroantral fistula (OAF) is an epithelialised oroantral communication (OAC). OAC refers to an abnormal connection between the oral cavity and antrum. The creation of an OAC is most commonly due to the extraction of a maxillary (upper) tooth closely related to the antral floor. A small OAC may heal spontaneously but a larger OAC would require surgical closure to prevent the development of persistent OAF and chronic sinusitis.

Nasal surgery is a medical procedure designed to treat various conditions that cause nasal blockages in the upper respiratory tract, for example nasal polyps, inferior turbinate hypertrophy, and chronic rhinosinusitis. It encompasses several types of techniques, including rhinoplasty, septoplasty, sinus surgery, and turbinoplasty, each with its respective postoperative treatments. Furthermore, nasal surgery is also conducted for cosmetic purposes. While there are potential risks and complications associated, the advancement of medical instruments and enhanced surgical skills have helped mitigate them.

Odontogenic sinusitis is a type of sinusitis, specifically caused by dental infections or procedures. Comprising approximately 10-12% of all chronic sinusitis cases, this condition primarily affects the maxillary sinus, which is in close proximity to the upper teeth.

References

  1. 1 2 3 4 5 Lt Col BS Tuli (2005). Text book of Ear, Nose & Throat (First ed.). Jaypee Brothers Medical Publishers. pp. 495, 496, 497. ISBN   978-81-8061-446-0.
  2. ↑ Maheshwari, Dr.Sharad; Kumar, Dr.Subirendra (2003). TEXTBOOK of E.N.T. (First ed.). ARYA PUBLICATIONS. p. 333. ISBN   978-81-7855-128-9.
  3. ↑ Ramadan, HH; Owens, RM; Tiu, C; Wax, MK (1998). "Role of Antral Puncture in treatment of sinusitis in the intensive care unit". Otolaryngol Head Neck Surg. 119 (4): 381–4. doi:10.1016/s0194-5998(98)70083-x. PMID   9781995. S2CID   22678588.
  4. 1 2 3 4 5 6 Bhargava, S.K; Bhargava, K.B; Shah, T.M (2002). A Short Textbook of ENT Diseases (6 ed.). Usha Publications. pp. 183–5. ISBN   978-8190098434.
  5. ↑ Jibiinkoka, Nihon; Gakkai, Kaiho (Sep 2002). "Bacterial examination of sinusitis using antral puncture and irrigation". Nihon Jibiinkoka Gakkai Kaiho. 105 (9): 925–30. doi: 10.3950/jibiinkoka.105.925 . PMID   12400169.
  6. ↑ Christensen, O; Gilhuus Moe, O (1979). "Surgical treatment of chronic hyperplastic sinusitis and maxillary sinus empyema of oral/dental origin". International Journal of Oral Surgery. 8 (4): 276–282. doi:10.1016/s0300-9785(79)80049-6. PMID   120331.
  7. ↑ Elwany, Samy. "Procedures and operations of nasal and Paranasal sinuses" (PDF).
  8. ↑ Toran, KC (2010). "Is Antral Washout really indicated in Acute Bacterial Rhino Sinusitis". Nepalese Journal of ENT Head and Neck Surgery. 1 (1): 12–13. doi: 10.3126/njenthns.v1i1.4730 .
  9. 1 2 3 Greval, RS; Khurana, S; Goyal, SC (1990). "Incidence of fungal infections in chronic maxillary sinusitis". Indian Journal of Pathology & Microbiology. 33 (4): 339–343. PMID   2132501.
  10. 1 2 3 4 Bansal, Mohan (2013). Diseases of ear, nose and throat : head and neck surgery (1 ed.). New Delhi: Jaypee. p. 561. ISBN   9789350259436.
  11. ↑ De, S.K (2005). Surgery ENT Head and Neck. New Book Stall. ISBN   978-8187447160.
  12. ↑ Adachi, M; Furuta, S; Suzuki, S; Maeda, T (Sep 2002). "Bacterial examination of sinusitis using antral puncture and irrigation". Nihon Jibiinkoka Gakkai Kaiho. 105 (9): 925–930. doi: 10.3950/jibiinkoka.105.925 . PMID   12400169.
  13. ↑ Ezeanolue, BC; Nwagbo, DF; Aneke, EC (2000). "Correlation of plain radiological diagnostic features with antral lavage results in chronic maxillary sinusitis". West Africa Journal of Medicine. 19 (1): 16–18. PMID   10821080.
  14. ↑ Jackson, J.P., ed. (1991). A Practical Guide to Medicine and the Law (1 ed.). London: Springer London. p. 296. ISBN   9781447118633.
  15. ↑ Thomson, K.F.M (29 June 2007). "Air embolism following antral lavage". The Journal of Laryngology & Otology. 69 (12): 829–832. doi:10.1017/S0022215100051483. PMID   13278643. S2CID   37334672.
  16. ↑ Muthubabu, K; Srinivasan, MK; Sakthivel, M; Kumar, Kiran; Kumar, Arvindh (2014). "Comparison of endoscopic sinus surgery and antral wash out in the management of subacute and chronic maxillary sinusitis". International Journal of Medical Research & Health Sciences. 4 (2): 302–4. doi:10.5958/2319-5886.2015.00056.9.
  17. ↑ Axelsson, A; Chidekel, N; Grebelius, N (1970). "Treatment of acute maxillary sinusitis. A comparison of four different methods". Acta Oto-Laryngologica. 70 (1): 71–6. doi:10.3109/00016487009181861. PMID   4989705.
  18. ↑ Malm, L (1994). "Pharmacological background to decongesting and anti-inflammatory treatment of rhinitis and sinusitis". Acta Oto-Laryngologica Supplementum. 515: 515:53–5. doi:10.3109/00016489409124325. PMID   7520660.
  19. ↑ Zeiders, JW; Dahya, ZJ (2011). "Antral lavage using the Luma transilluminaton wire and vortex irrigator--a safe and effective advance in treating pediatric sinusitis". International Journal of Pediatric Otorhinolaryngology. 75 (4): 461–3. doi:10.1016/j.ijporl.2010.11.021. PMID   21295864.
  20. ↑ Stammberger, H (1986). "Endoscopic endonasal surgery--concepts in treatment of recurring rhinosinusitis. Part I. Anatomic and pathophysiologic considerations". Otolaryngology–Head and Neck Surgery. 94 (2): 143–7. doi:10.1177/019459988609400202. PMID   3083326. S2CID   34575985.
  21. ↑ Stammberger, H (1986). "Endoscopic endonasal surgery--concepts in treatment of recurring rhinosinusitis. Part II. Surgical technique". Otolaryngology–Head and Neck Surgery. 94 (2): 147–56. doi:10.1177/019459988609400203. PMID   3083327. S2CID   10542945.
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