Friday, July 20, 2012

3 techniques used for maxillary sinus drainage


Three surgical techniques are often used for facilitating maxillary sinus drainage: canine puncture, inferior meatal and natural osmium.






 Canine Puncture Technique 
The canine puncture technique has been practiced since mid eighteenth century, when Lamorier invented it. The canine puncture is one of the popular options for the maxillary sinus drainage procedure for various reasons. Bleeding is the least as compared to other two techniques. It requires less time. Syncope (loss of coconsciousness) is rare. Since it is relatively safe, surgeons use only this technique for children. 
The canine fossa is located near the canine tooth root that is palpable. The canine fossa is punctured to access the maxillary sinus and then purulent material is removed from the sinus using a syringe. The sinus and canine fossa are irrigated with warm saline and then patient lean forward, so that the saline escapes the nasal cavity. The aerobic, anaerobic, Gram Stain and fungal culture tests are performed on the purulent material.


Inferior Meatal Technique
In the end of the nineteenth century, Miculicz pioneered the technique, which is still popular. The technique involves puncturing the inferior meatus to enter the maxillary sinus. Mild pressure is applied on the sinus while accessing it. Then, a syringe is used to collect the aspirate from the sinus. The aspirates are used for cultures. The sinus is irrigated with warm saline to finish the procedure. Since the technique targets lower part of the sinus, chances of puncturing the soft tissues are minimum. However, it may be difficult to penetrate the thick bony wall.Natural Ostium 


Technique During the process, the surgeon inserts a cannula with syringe into the middle meatus occupying the posterior infundibulum to access the maxillary sinus’s natural ostium. After collecting cultures, the sinus is washed with warm saline. No bone is penetrated during the procedure, so chances of osteomyelitis are non-existent. However, finding natural ostium is difficult and mechanical trauma due to this procedure may cause stenosis in the natural ostium region. Proximity of the natural ostium access point to the orbit furthers the risk. Chances of bleeding from the vascular and slim nasal mucosa are also high.

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