Intranasal antrostomy

Before you agree to have your sinus surgery it is sensible to know all you can about it. The information here is a guide to common medical practice. Each hospital and doctor will have slightly different ways of doing things, so you should follow their guidance where it is different from the information given here. Because all patients, conditions and treatments vary it cannot cover everything. Use this information when making your sinus surgery treatment choices with your doctors. You should mention any worries you have. Remember that you can ask for more information at any time.

What is the problem?

There is an infection in the sinus in the cheekbone (maxilla). The sinus has become blocked. You may be having pain in your cheekbone. You may have pain around the eye or in the forehead. Sometimes the pain may be felt in the upper teeth and mistaken for toothache.

The pain is coming from inflammation of the sinus in the maxilla, a condition called sinusitis.

What is a sinus?

The cheekbone is hollow and the space inside is called a sinus. This sinus is called the maxillary sinus. It is sometimes called the maxillary antrum. The maxillary sinus is connected to the inside of the nose by a very small hole.

What has gone wrong?

Infection in a sinus causes a secretion of fluid. Usually this fluid will drain away through the small opening into the nose. In your case the infection has blocked the opening from the sinus into the nose. The sinus lining may be very swollen. The liquid may be completely sealed off from the nose, forming a cyst.

The infection can start as a cold (virus) or may be an infection with bacteria. Dental infections can spread to the maxillary sinus. This happens because the roots of some of the teeth are very close to the lining of the sinus. Injury to the bones surrounding the sinuses may also cause infection, as may swimming in dirty water.

The aims

The aim of the operation is to make a new opening into the blocked sinus. This will let it drain properly. We can also pass instruments through the new opening and remove any swollen lining or cyst.

You will usually have a full general anaesthetic and be completely asleep while the operation is carried out. It may be possible to do the operation under a local anaesthetic with or without sedation. You should discuss these options with your surgeon or anaesthetist.

The benefits

Having made a new opening into the sinus, infection can drain away. Antibiotic tablets will have a better chance of clearing the infection completely.

Are there any alternatives?

Repeated courses of antibiotics are unlikely to clear a blocked sinus.

What if you do nothing?

You may continue to have sinus infection. Your doctor can prescribe more antibiotics for you.

Who should have it done?

People who have infection in the maxillary sinus, which has blocked the opening into the nose, should have the operation.

Who should not have it done?

People who have other medical conditions that would make it unsafe for them to have a general anaesthetic should not have one.

It may be possible to do the operation under a local anaesthetic with or without sedation. You should discuss these options with your surgeon or anaesthetist.

Author: Mr Robert Ruckley MB. ChB.  F.R.C.S.  Consultant ENT surgeon.

© Dumas Ltd 2006

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