Antrostomy: Surgical Approaches, Indications, and Postoperative Care

Antrostomy creates a permanent opening (stoma) between the maxillary sinus and nasal cavity to establish drainage and ventilation. It treats chronic maxillary sinusitis refractory to medical management.

Surgical Approaches

Approach	Access	Key Features
Endoscopic (Middle Meatal)	Transnasal, rigid endoscopes	Minimally invasive; preserves mucosa; enlarges natural ostium; standard today
Caldwell-Luc	Vestibular incision (canine fossa)	Direct visualization; larger antrostomy; more morbidity (numbness, dental injury); reserved for tumors, fungal balls, revision
Denker's (Modified Caldwell-Luc)	Vestibular + canine fossa window	Better access to anterior/inferior sinus

Indications

• Chronic rhinosinusitis (CRS) refractory to ≥12 weeks medical therapy (antibiotics, steroids, irrigation).
• Recurrent acute sinusitis (≥4 episodes/year).
• Fungal sinusitis (fungal ball, allergic fungal).
• Mucocele / pyocele.
• Antrochoanal polyp.
• Tumor biopsy/resection access.
• Oroantral fistula repair.

Procedure (Endoscopic)

1. Anesthesia: General ± local vasoconstriction.
2. Uncinate process resection → identify natural ostium.
3. Enlarge ostium posteriorly/inferiorly with biting forceps / microdebrider.
4. Remove disease (polyps, fungus, mucosa).
5. Optional: Silastic stent / balloon dilation / drug-eluting implant (PROPEL).

Postoperative Care

• Nasal saline irrigations (start 24h postop; 2–4× daily).
• Topical steroids (post-healing).
• Debridement visits (1, 2, 4, 6 weeks).
• Antibiotics if purulence intraop.
• Stent removal at 2–4 weeks if placed.

Complications

• Orbital injury (lamina papyracea penetration) — rare with navigation.
• Nasolacrimal duct injury → epiphora.
• Posterior epistaxis (sphenopalatine artery).
• Synectasis / adhesions.
• Recurrence (CRS is chronic; surgery controls, doesn't cure).