4Indications Diagnosis & treatment of chronic maxillary sinusitis not responding to conservative medications Cytology/culture sensitivity of antral contentsContraindications Age < 3 yrs Hypoplastic maxilla with thick bony walls Acute maxillary sinusitis untreated by antibiotics Trauma to maxillary sinus or Fracture of orbital floor Drainage of maxillary antral hematoma
10Anesthesia: L. A. for adults. G. A. for children & un-cooperative pt Anesthesia: L.A. for adults. G.A. for children & un-cooperative pt. Position: Sitting / supine.Technique: Puncture lateral wall of inferior meatus with Tilley-Litchwitz antral trocar & cannula, just anterior to turbinate genu, trocar directed towards tragus of ipsilateral ear, with gentle boring action. Advance till it hits posterior wall, then withdraw slightly. Remove trocar & wash sinus with saline at 370 C with pt leaning forwards & saying k k. Wash till clear fluid comes. Remove cannula.
11Complications 1. Hemorrhage ( Lateral Sphenopalatine artery) 2. Pain & swelling of cheek (breach of anterior wall)3. Orbital damage (perforation of orbital floor)4. Perforation of posterior wall (maxillary artery injury)5. Vasovagal attack6. Fatal air embolism
12Intranasal antrostomy (INA) Region of antral puncture in inferior meatus perforated with Tilley's antral harpoon.Antrostomy enlarged with Tilley's antral burr or Myle’s nasoantral perforator.
33Frontal sinus trephination 2-cm incision made 1 cm below medial end ofeyebrow & deepened up to bone. Frontal sinusfloor opened by drilling with burr. Openingenlarged with Citelli’s punch forceps to drain pus.Drainage tube inserted inside frontal sinus cavity& sutured in place. Regular lavage of the frontalsinus done through drainage tube for hourspost-operatively.