Name of the Procedure:

Lavage by cannulation; maxillary sinus (antrum puncture or natural ostium)

Summary

Lavage by cannulation of the maxillary sinus is a medical procedure where a healthcare provider cleanses the maxillary sinus by inserting a tube (cannula). This can be done either through a small puncture in the sinus wall or via the natural opening (ostium) of the sinus.

Purpose

This procedure helps to clear out mucus and pus from the maxillary sinus, which can relieve symptoms of sinus infections, improve sinus drainage, and assist in the diagnosis and treatment of sinus conditions.

Indications

• Chronic sinusitis not responding to medication
• Recurrent sinus infections
• Accumulation of mucus or pus in the sinus
• Diagnostic purposes to obtain a sample of sinus contents
• Facial pain or pressure related to sinus issues

Preparation

• Patients may be advised to stop taking certain medications, such as blood thinners, a few days prior to the procedure.
• Fasting might be required if general anesthesia is to be used.
• Diagnostic imaging, such as a CT scan, may be performed to evaluate the sinuses.

Procedure Description

1. The patient is positioned comfortably, lying back in a chair or on an exam table.
2. Local anesthesia is administered to numb the nasal area and sinus cavity.
3. A cannula (a thin, hollow tube) is inserted either through a small puncture in the maxillary sinus wall or via the natural ostium.
4. Sterile saline or a medicated solution is flushed through the cannula to rinse out the sinus cavity.
5. The fluid and any dislodged mucus or pus are suctioned out.
6. The cannula is removed, and the area is cleaned.

Duration

The procedure typically takes about 15-30 minutes.

Setting

The procedure is usually performed in an outpatient clinic or an office-based setting.

Personnel

• Otolaryngologist (ENT specialist)
• Nurse or medical assistant

Risks and Complications

• Discomfort or pain during and after the procedure
• Bleeding from the puncture site
• Infection
• Nasal drainage or congestion
• Rarely, damage to adjacent structures

Benefits

• Relief from sinus pressure and pain
• Improved sinus drainage
• Reduced incidence of sinus infections
• Quick recovery time, as it is minimally invasive

Recovery

• Patients can usually go home shortly after the procedure.
• Over-the-counter pain medication might be recommended.
• Saline nasal sprays or rinses may be advised to keep the sinuses clear.
• Avoid strenuous activities for a few days.
• Follow-up appointments may be scheduled to monitor recovery.

Alternatives

• Antibiotic therapy for infection control
• Oral or nasal corticosteroids to reduce inflammation
• Functional endoscopic sinus surgery (FESS) for more persistent or severe cases
• Balloon sinuplasty as a less invasive surgical option Pros and cons:
• Medications can be less invasive but might not be effective for chronic issues.
• Surgical options might offer more permanent relief but come with higher risks and longer recovery times.

Patient Experience

• During the procedure, patients may feel pressure or a strange sensation as the sinus is flushed.
• Some mild pain or discomfort might be experienced afterward, which can be managed with pain medication.
• Post-procedure, patients often feel relieved from sinus congestion and pain within a few days.