Antrostomy

Anesthesia Implications

Position: Supine, Bed turned 90 degrees
Time: 1-2 hours (average)
Blood Loss: Low (10-50 ml)
Post-op Pain: Minimal (1-3)
Maintenance Paralytic: Not required but can be given to prevent coughing

Preop – The patient will receive a nasal decongestant (commonly oxymetazoline).

Approach – GETT with an oral Rae and LTA. Paralytic is not technically required, but sometimes given to prevent coughing.

Intraop Considerations – Give a full run of PONV prophylaxis. Have an NGT available for the surgeon to pass orally after the throat pack is removed. Avoid hypertension but ensure the BP stays within 20% of the patient’s baseline. Consider a beta-blocker with emergence.

Emergence – ensure it is smooth and avoid coughing- lidocaine 0.25mg/kg may be useful. If the surgeon does not suction the stomach, be sure to do so before extubating.

An antrostomy is performed for patients with chronic maxillary sinusitis. The surgery is preformed to reestablish proper drainage. A CT scan is completed to confirm chronic sinusitis and used to check for things like positioning of the skull base and nasolacrimal duct.

A passage is created from the nostrils into the maxillary sinus, and frequently, the passage can become obstructed. In such cases, a procedure called a uninectomy is also carried out to unblock the osteomeatal complex. The osteomeatal complex is made up of the ethmoid bulla, infundibulum, maxillary ostium, and uncinate process.

The patient will receive vasoconstrictors such as topical cocaine to decongest the nasal passages. If needed, the surgeon will perform a uninectomy and identify the natural ostium to begin the antrostomy. He/she will widen the ostium and use forceps to enlarge it. The maxillary sinus will then be inspected to ensure no further disease is present. If a polyp is present, it will be removed with suction or forceps.