ANTRAL WASH /ANTRAL LAVAGE

--Ravi Bhushan

Also known as Proof puncture or Antral irrigation

• DEFINITION :- It is process of puncturing the medial wall of maxillary sinus in region of inferior meatus and irrigating the sinus.

Indications

Chronic or subacute maxillary sinusitis which failed to respond conservative medication.

To collect specimen of antral content for culture and sensitivity, or cytologic examination.

Contraindications

child under the age of 3 years.

Hypoplastic maxilla with thick bony walls.

Presence of trauma which has disrupted orbital floor .

Anaesthesia

• L.A. – in adults - (pack of 4 % lignocaine

with adrenaline is kept in inferior meatus for 10 –15 min.

• G.A. – in childrens and anxious adults.

Surgical technique

position of patient – • Sitting position when L.A. is used.

• Tonsillectomy position with Boyle- Davis gag in place or reverse trendelenburg position with 15 degree head flexion and throat pack when G.A. is used

Lateral wall of inferior meatus is punctured using Tilly-Lichtwitz trocar & cannula

-(at a point 1.5 cm from anterior end of inferior turbinate and near attachment of concha with lateral wall).

Tilly-Lichtwitz trocar & Cannula

Head is held steady and trocar is directed towards tragus of ipsilateral ear.

now trocar is removed .cannula is advanced until it reaches

opposite antral wall . then withdrawn a little.

Antrum is irrigated with NORMAL SALINE at 37 degree celsius with HIGGINSON’S SYRINGE.

Syringing is continued till return is clear

After puncture is over cannula is removed and pack is kept on inferior meatus to control bleeding.

THE MAXILLARY ANTRUM. A, an antral washout. Push a cannula into a patient's antrum through the lateral wall of his nose in his inferior meatus. Wash the contents of his antrum out through the ostium. B, an intranasal antrostomy. After Bull PB, 'Lecture Notes on Diseases of the Ear, Nose and Throat; (6th edn). Blackwell Scientific Publications, permission requested.

Diagnosis of antral pathology

Amber coloured fluid immediately after puncture containing cholesterol crystals – antral cyst

Blobs of mucopus – hyperplastic sinusitis

Foul smelling pus - suppuration

Post operative care

Antibiotics for 5-6 days in case of suppuration.

Pack is removed after ½ hr.Nasal decongestant drops to improve

nasal patency.Analgesics for post-operative pain.

Complications

Swelling of cheek - when cannula lies in soft tissue over anterolateral wall of maxilla and fail to pierce nasoantral wall.

Orbital injury and cellulitis - when trocar and cannula pierces the roof of antrum.

Puncture of post antral wall - causes swelling of posterior part of cheek.

Bleeding due to injury to nasal mucosa.

Air embolism is rare but fatal complication

thank you

• references :-• 1. Diseases of ear , nose and throat

5th edition - P L Dhingra

• 2. Scott Brown’s Otorhinolaryngology Head and Neck Surgery 7th edition

• 3. Lecture Notes on Diseases of the Ear, Nose and Throat; (6th edn). Blackwell Scientific Publications.

• 4. Science photo library.

• 5. Google images.