A maxillary antrostomy is a common procedure performed to improve the health and function of the maxillary sinuses, which are the largest pair of sinuses located behind the cheekbones. This surgical technique is designed to clear and widen the natural drainage pathway of the sinus, known as the ostium. By establishing better ventilation and allowing accumulated mucus to drain efficiently, the procedure aims to reduce the frequency and severity of sinus infections. Maxillary antrostomy is typically carried out as a component of Functional Endoscopic Sinus Surgery (FESS) and uses specialized instruments inserted through the nostril.
Conditions That Require Maxillary Antrostomy
Maxillary antrostomy is necessary when the natural opening (ostium) of the maxillary sinus becomes blocked or too narrow, preventing normal mucus clearance. This blockage is the underlying anatomical problem leading to persistent inflammation and infection. The most frequent indication for this surgery is chronic rhinosinusitis (CRS), specifically when the condition does not improve after an adequate trial of medical treatments like antibiotics, nasal steroids, and saline rinses.
Obstruction prevents the hair-like structures, called cilia, from effectively moving mucus out of the sinus cavity. When mucus and trapped air cannot escape, it creates a favorable environment for bacteria or fungus to grow, leading to recurrent acute infections or persistent chronic inflammation. Other conditions that may prompt a maxillary antrostomy include nasal polyps, which are benign growths that physically block the sinus opening.
The surgery is also performed to remove cysts, tumors, or fungal concretions (fungus balls) from within the maxillary sinus cavity. Additionally, odontogenic infections, which originate from dental issues, can spread into the sinus, requiring the antrostomy to access and clear the infection. A computed tomography (CT) scan is routinely used before the surgery to precisely identify the extent of the disease and the specific anatomical blockages.
The Endoscopic Surgical Process
Maxillary antrostomy is performed endoscopically, meaning the surgeon accesses the sinus through the nostril using a thin tube equipped with a light and camera. This technique is minimally invasive and avoids external incisions, and it is usually conducted under general anesthesia.
The procedure often begins with the removal of the uncinate process, which is a small, curved piece of bone and tissue that covers the natural opening of the maxillary sinus. Removing the uncinate process (uncinectomy) allows the surgeon to visualize the natural ostium. It is important to correctly identify and incorporate the natural opening into the newly created larger antrostomy. If the surgeon were to miss the natural ostium, it could lead to mucus recirculation, where secretions move between two openings without properly draining.
Using specialized micro-instruments, the surgeon carefully enlarges the natural opening in a posterior and inferior direction. This controlled widening of the opening creates a permanent pathway for drainage and ventilation. The surgeon may then use angled endoscopes to look inside the sinus cavity and remove any diseased tissue, polyps, or thick mucus. The goal is to establish a wide connection between the maxillary sinus and the nasal passage, restoring the natural flow.
Navigating Recovery and Follow-Up Care
Patients can expect a recovery period that involves discomfort, nasal congestion, and minor bloody discharge for the first few days following the procedure. The initial post-operative experience often feels similar to a severe cold or sinus infection due to internal swelling and the presence of dried blood and crusting. Pain is generally mild to moderate and can be managed with prescribed pain medication, though non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin should be avoided for several weeks because they increase the risk of bleeding.
For optimal healing, patients should keep their head elevated, especially during the first night, and avoid strenuous activity, heavy lifting, or bending over for about one week. These actions can increase blood pressure in the head and trigger post-operative bleeding. Patients should also not blow their nose for at least a week to prevent trauma to the surgical site.
Follow-up appointments are scheduled shortly after the surgery, typically within three to seven days, to remove any nasal packing and assess the initial healing. Regular use of saline nasal irrigation is a key component of post-operative care. This helps to keep the nasal passages moist, flush out crusting and debris, and prevent the newly created opening from closing or scarring. Most people are able to return to work or school within a week, with complete healing usually occurring over one to two months.