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.
In contemporary practice, endoscopic sinus surgery has largely replaced antral lavage and as such, it is rarely performed.
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]
Plain Radiological X-rays (Water's view) of sinuses is most specific non- invasive method of diagnosing Antral pathology.[13]
The following difficulties may arise during antral lavage:[4]
Hard Bone: The wall of the maxillary sinus may be hard, rendering the procedure difficult.
Touching the posterior wall of the sinus by the tip of the cannula may block the cannula and the fluid may not return on pumping the higginson syringe. The cannula is slightly withdrawn and it becomes patent.
Blocked ostium: If the ostium of the sinus is blocked, the fluid doesn't return through it. To bypass the ostium, one more trocar and cannula are inserted at the site of the first one, a fluid returns through the other cannula.
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]
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.
Functional Endoscopic Sinus Surgery (FESS) is one of the newer modalities in treatment of Chronic Sinusitis. However, it is not first line of treatment as it may lead to massive bleeding. It allows ventilation and drainage of inflamed or infected sinuses and restoration of mucociliary clearances. It has proven to be very effective in treatment of acute and chronic sinusitis.[20][21]
^ abcdeLt Col BS Tuli (2005). Text book of Ear, Nose & Throat (First ed.). Jaypee Brothers Medical Publishers. pp. 495, 496, 497. ISBN978-81-8061-446-0.
^Maheshwari, Dr.Sharad; Kumar, Dr.Subirendra (2003). TEXTBOOK of E.N.T. (First ed.). ARYA PUBLICATIONS. p. 333. ISBN978-81-7855-128-9.
^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. PMID9781995. S2CID22678588.
^ abcdefBhargava, S.K; Bhargava, K.B; Shah, T.M (2002). A Short Textbook of ENT Diseases (6 ed.). Usha Publications. pp. 183–5. ISBN978-8190098434.
^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. PMID120331.
^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. PMID10821080.
^Jackson, J.P., ed. (1991). A Practical Guide to Medicine and the Law (1 ed.). London: Springer London. p. 296. ISBN9781447118633.
^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. PMID4989705.
^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. PMID7520660.
^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. PMID21295864.
^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. PMID3083326. S2CID34575985.
^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. PMID3083327. S2CID10542945.