Antral lavage - wikipedia Antral lavage This article has multiple issues. Please help improve it or discuss these issues on the talk page. ( Learn how and when to remove these template messages ) This article is an orphan, as no other articles link to it. Please introduce links to this page from related articles ; try the Find link tool for suggestions. ( December 2015 ) This article may require cleanup to meet Wikipedia 's quality standards. The specific problem is : Issues with the manual of style, currently has far too many lists. Should be expanded and written into prose. Please help improve this article if you can. ( October 2015 ) Antral lavage ( edit on Wikidata ) Antral lavage is a surgical procedure in which a cannula is inserted into the opening of the maxillary sinus via the inferior meatus to allow irrigation and drainage of the sinus. 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. Contents 1 Medical uses 2 Contraindications 3 Instruments 4 Diagnosis of antral pathology 5 Difficulties 6 Complications 7 Repetition 8 Post operative 9 Newer techniques 10 References Medical uses It can be used as therapeutic procedure for : Acute and chronic maxillary sinusitis not responding to medical treatment. Chronic infections not responding to treatments. Irrigating and washing out collected purulent secretions. Dental maxillary sinusitis. Oro - antral fistula if associated with sinusitis. Acute Bacterial Rhinosinusitis. Though it is indicated only in severe cases not as a regular treatment. It can be also used as diagnostic procedure for : Carrying out culture and sensitivity test if the returning fluid is mucopurulent or purulent in Chronic Sinusitis. Exfoliative cytology of the returning fluid to rule out any malignancy. Contraindications Age : Below the age of 3 years, as the size of the sinus is small due to underdeveloped Maxillary Sinus. Bleeding disorders : May lead to epistaxis. Fracture of maxilla : Antral Lavage may result in escape of the fluid through fracture lines. Febrile stage of acute maxillary sinusitis : May cause osteomyelitis of Maxilla. Procedure is contraindicated in diabetic and hypertensive patients. Acute maxillary sinusitis not resolving on medical treatment. Instruments The following instruments are used in the procedure : Tilley 's Forceps Lichtwitz Antral Trocar Cannula Higginson 's Rubber Syringe Nasal Speculum Diagnosis of antral pathology Watery, amber color fluid flowing from cannula, immediately on puncture and containing cholesterol crystals, indicates presence of cyst. Blobs of mucopus in washings indicates hyperplastic sinusitis. 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. Plain Radiological X-rays ( Water 's view ) of sinuses is most specific non - invasive method of diagnosing Antral pathology. Difficulties The following difficulties may arise during antral lavage : 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 does n'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. Complications 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. Bleeding may occur at the site of the puncture which stops in a short time with cotton wool plug. 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. Infection in the maxillary sinus is common. Anaesthetic complications may occur. Air embolism. 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. 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. Post operative Patient lies down for 10 -- 15 minutes after operation and pack is removed after an hour. Antibiotic should be given for 5 -- 6 days in cases of suppuration depending upon culture and sensitivity. Oral and local decongestant are given to improve the patency of ostium. Analgesics may be required for post-operative headache. Newer techniques Luma Wire Transillumination : This technique has a number of advantages over antral Lavage, such as : 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. References ^ Jump up to : Lt Col BS Tuli ( 2005 ). Text book of Ear, Nose & Throat ( First ed. ). Jaypee Brothers Medical Publishers. pp. 495, 496, 497. ISBN 81 - 8061 - 446 - 8. Jump up ^ Maheshwari, Dr. Sharad ; Kumar, Dr. Subirendra ( 2003 ). TEXTBOOK of E.N.T ( First ed. ). ARYA PUBLICATIONS. p. 333. ISBN 81 - 7855 - 128 - 4. Jump up ^ 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 Surgery. 119 : 381 -- 4. doi : 10.1016 / s0194 - 5998 ( 98 ) 70083 - x. PMID 9781995. ^ Jump up to : Bhargava, S.K ; Bhargava, K.B ; Shah, T.M ( 2002 ). A Short Textbook of ENT Diseases ( 6 ed. ). Usha Publications. pp. 183 -- 5. ISBN 8190098438. Jump up ^ Jibiinkoka, Nihon ; Gakkai, Kaiho ( 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. Jump up ^ 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 : 276 -- 282. doi : 10.1016 / s0300 - 9785 ( 79 ) 80049 - 6. PMID 120331. Jump up ^ Elwany, Samy. `` Procedures and operations of nasal and Paranasal sinuses '' ( PDF ). Jump up ^ Toran, KC ( 2010 ). `` Is Antral Washout really indicated in Acute Bacterial Rhinosinisitis '' ( PDF ). Nepalese Journal of ENT Head and Neck Surgery. 1 ( 1 ) : 12 -- 13. Archived from the original ( PDF ) on 2015 - 12 - 22. ^ Jump up to : 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. ^ Jump up to : Bansal, Mohan ( 2013 ). Diseases of ear, nose and throat : head and neck surgery ( 1 ed. ). New Delhi : Jaypee. p. 561. ISBN 9789350259436. Jump up ^ De, S.K. Surgery ENT Head and Neck. ISBN 8187447168. Jump up ^ 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. Jump up ^ 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 : 16 -- 18. PMID 10821080. Jump up ^ Jackson, J.P., ed. ( 1991 ). A Practical Guide to Medicine and the Law ( 1 ed. ). London : Springer London. p. 296. ISBN 9781447118633. Jump up ^ 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. Jump up ^ 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. Jump up ^ Axelsson, A ; Chidekel, N ; Grebelius, N ( 1970 ). `` Treatment of acute maxillary sinusitis. A comparison of four different methods ''. Acta Oto - Laryngolica. 70 ( 1 ) : 71 -- 6. doi : 10.3109 / 00016487009181861. PMID 4989705. Jump up ^ Malm, L ( 1994 ). `` Pharmacological background to decongesting and anti-inflammatory treatment of rhinitis and sinusitis ''. Acta Oto - Laryngolica Supplementum. 515 : 515 : 53 -- 5. PMID 7520660. Jump up ^ 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 Paediatric Otorhinolaryngology. 75 : 461 -- 3. doi : 10.1016 / j. ijporl. 2010.11. 021. PMID 21295864. Jump up ^ Stammberger, H ( 1986 ). `` Endoscopic endonasal surgery -- concepts in treatment of recurring rhinosinusitis. Part I. Anatomic and pathophysiologic considerations ''. Otolaryngology -- Head and Neck Surgery. 94 : 143 -- 7. doi : 10.1177 / 019459988609400202. PMID 3083326. Jump up ^ Stammberger, H ( 1986 ). `` Endoscopic endonasal surgery -- concepts in treatment of recurring rhinosinusitis. Part II. Surgical technique ''. Otolaryngology -- Head and Neck Surgery. 94 : 147 -- 56. doi : 10.1177 / 019459988609400203. PMID 3083327. Retrieved from `` https://en.wikipedia.org/w/index.php?title=Antral_lavage&oldid=813360400 '' Categories : Otorhinolaryngology Surgical procedures and techniques Hidden categories : Orphaned articles from December 2015 All orphaned articles Articles needing cleanup from October 2015 All pages needing cleanup Cleanup tagged articles with a reason field from October 2015 Wikipedia pages needing cleanup from October 2015 Articles with multiple maintenance issues Talk Contents About Wikipedia Add links This page was last edited on 3 December 2017, at 07 : 37. Text is available under the Creative Commons Attribution - ShareAlike License ; additional terms may apply. By using this site, you agree to the Terms of Use and Privacy Policy. Wikipedia ® is a registered trademark of the Wikimedia Foundation, Inc., a non-profit organization. About Wikipedia

Question: the washing or irrigating of the sinuses of patients who are failing to respond to treatment
Answer: Antral lavage