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Maxillary Antrostomy Sinus Surgery

by Sarah Syakira
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Maxillary antrostomy is a surgery performed on the patient’s sinuses to enlarge the maxillary sinus opening. It is likely that later there will be further surgery in the Maxillary sinus cavity and this will make drainage of the sinuses better.

Surgery called the Maxillary Antrostomy has been practiced for a long time, in the mid-1980s, surgery has been done and this method is a possible healing approach for patients with chronic sinusitis (sinuses that cannot be treated in any other way). This is the best treatment option for you and is an endoscopic sinus surgery procedure. While standard therapy to treat chronic sinus is to give antibiotics (3-6 weeks), saline irrigation, nasal steroids.

Maxillary antrostomy is also known by the names: endoscopic middle meatal maxillary antrostomy, and middle meatal antrostomy.

How to Diagnose Chronic Sinuses

Before being treated, the doctor must first make sure that the sinuses you are experiencing are chronic sinuses, the way is to do a CT scan. They use X-rays because with this method only shows sinus disease and incomplete information about the sinus that is experienced.

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However, with a CT scan, this tool not only shows the severity of the sinuses but also before starting surgery, the doctor confirms with a CT scan that the patient has chronic sinus problems. So the CT scan not only shows the severity of the maxillary sinuses but also provides complete information regarding the sinuses. Among the important information obtained from a CT scan are:

  • Position or location of the nasolacrimal duct
  • Uncinate process – essential in surgery
  • Thickening of the mucous membrane
  • Air vs fluid in the sinus cavity
  • Polyps, and
  • Osteomeatal complex obstruction: prevents drainage of the maxillary sinus

Even though many medical terms are used, the presence of this information that is presented by a CT scan is very helpful for the surgeon to do his job. The osteomeatal complex consists of the following four structures:

  • Uncinate process: Removal of the L-shaped bone
  • Maxillary ostium: Opening of the maxillary sinus
  • Infundibulum: a curved duct in the nose
  • Ethmoid bulla: One of several ethmoid sinuses

Preparation for Endoscopic Sinus Surgery and Maxillary Antrostomy

Before undergoing surgery, the patient will be instructed not to eat and drink anything from half the night until the end of the surgery. This will prevent your risk of inhaling stomach contents. During the surgery, you will be given an Afrin nasal spray, the purpose of which is to help increase the visibility area during the surgery. After the anesthesia, the doctor will give you gauze that has been soaked with afrin or cocaine, and it will be placed on your nose, the goal is to increase visibility.

Goals

What is the goal? During surgery there are 4 things that doctors want to achieve in maxillary antrostomy

  • Eliminates the uncinate process
  • Can get a natural opening into the maxillary sinus
  • The opening in the maxillary sinus is enlarged
  • Removing polyps in the maxillary sinus cavity

At the start of surgery, the doctor must remove the uncinate process. It aims to visualize the opening of the sinuses. If the sinus opening doesn’t work and a new sinus opening is made, then you can recycle the sinus drainage. Come out of one hole and back into the sinus opening through the other nose.

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After a Maxillary Antrostomy Surgery

After the Maxillary Antrostomy surgery is completed, you will wake up in the post-anesthesia care unit (PACU). Here you are monitored whether there is bleeding or not. Are there other complications, or have nausea and so on. If everything is finished and no problems have occurred, then after 3 or 5 days you will see your doctor again to open your nose pack.

However, if you remove the dressing of your nose and you experience new problems, it will be discussed further with the doctor.

Risks

The risks involved in chronic sinusitis surgery do exist. Not only the risks from the surgery side, but there are also side effects that occur after surgery. Among the risks that may occur are:

  1. Injury around the eye
  2. Blindness
  3. Nasolacrimal duct injury
  4. The occurrence of nosebleeds (epistaxis)
  5. Cerebrospinal fluid (CSF) rhinorrhea
    Meningitis

But you don’t need to worry, because this risk is very rare and even almost non-existent except for nose bleeds which sometimes occur several times.

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