A maxillary sinus puncture is a procedure performed by an otorhinolaryngologist for diagnostic or therapeutic purposes. It helps to determine the severity of the pathological process, as well as changes in dynamics. In addition, this intervention facilitates the patient's condition.
Indications for the procedure
Puncture of the maxillary sinus is not prescribed for absolutely all patients with otorhinolaryngological problems. It is carried out only after a thorough examination. First, the doctor must collect an anamnesis, conduct an objective examination. Further, he prescribes non-invasive diagnostic methods, that is, those that do not require damage to the skin, like a puncture.
Diagnostic puncture of the maxillary sinus is performed only in cases where after all the above methods there are any ambiguities. But the therapeutic puncture is done in order to alleviatesymptoms and improve the patient's condition.
The main indications for this procedure may be as follows:
- prolonged headaches, the cause of which is not possible to find out in other ways;
- accumulation of a large amount of pus in the sinus;
- for examining the contents of the cyst of the maxillary sinus;
- taking a biopsy for examination under a microscope in case of suspected oncological process;
- For therapeutic purposes, a puncture is performed when drug therapy is ineffective and in the presence of bacterial inflammation in the maxillary sinus.
Procedure technique: first stage
Before the puncture, the mucous membrane of the nasal passage is treated with an anesthetic solution. This is necessary to prevent pain. To expand the vessels and the excretory duct of the sinus, the patient is injected with a solution of adrenaline. The puncture of the maxillary sinus is carried out through the lower nasal passage.
For puncture use a needle, the end of which is curved. If this is not available, then a lumbar puncture needle may be used. The doctor gently inserts it into the lower nasal passage to a depth of 2.5 cm, while carefully monitoring the process. The needle should rest against the arch of the nasal passage. This place was not chosen by chance. This is where the bone is thinnest, so piercing is easiest.
After that, the advancement of the needle changes towards the orbit. All the time, the doctor should hold the patient's head with one hand, and the needle with the other. This prevents displacementinstrument and damage to the wall of the nasal sinus. It is allowed to change the injection site if the initially chosen location is not sufficiently malleable.
The next steps of the procedure
The next step in the maxillary sinus puncture technique is to check the fistula patency. Further medical tactics depend on its results. If the syringe plunger is pulled out easily and then it does not return back, then the anastomosis is passable. Another sign of patency is that the fluid from the sinus flows freely into the nasal cavity. In this case, it is necessary to carefully remove the fluid in the sinus.
Next, the doctor washes the sinus with antiseptic solutions. The patient's head is tilted down and forward. A tray is placed under the patient's head, where the liquid is collected. This position prevents it from entering the throat or upper respiratory tract.
If necessary, at this stage, a puncture of the maxillary sinus with the introduction of drugs can be performed. At the same time, doctors administer antibiotics, proteolytic enzymes.
If it was found that the fistula is impassable, the doctor makes another puncture. The sinus is flushed through two needles.
The fluid obtained as a result of the puncture is collected in a sterile tube and sent to the laboratory for analysis.
If punctures are performed regularly, a catheter is inserted into the hole in the nasal passage. Further punctures are made through this tube. This method eliminates the need for a doctor to make a new puncture each time.
Contraindications to the procedure
Therapeutic and diagnostic puncture of the maxillary sinus, like any other study, has a number of contraindications.
This procedure should not be performed on young children as their sinuses are not yet as developed as those of an adult.
It is not recommended to intervene in people with severe concomitant diseases: diabetes mellitus in the stage of decompensation, high blood pressure, severe insufficiency of internal organs. Such patients should limit any invasive interventions as much as possible, as this may lead to a deterioration in their condition.
People with mental disorders are also prohibited from this procedure.
Separately allocate a group of patients who simply cannot perform a sinus puncture. This may be due to a thick bone wall or the presence of a pathology of its development.
Complications after the procedure
Complications of maxillary sinus puncture are very rare. However, sometimes they do happen. The following unwanted effects may occur:
- A sharp drop in blood pressure, or collapse. This is manifested by marble pallor, blue lips. Possible clouding of consciousness.
- Common purulent inflammation of the orbit - phlegmon. Appears due to the ingress of pus from the sinus.
- Injury to the tissues of the cheek with a needle.
- Infectious blood poisoning, or sepsis. Occurs when bacteria enter the bloodstream from the sinus.
- Hematomasoft tissues due to damage to the arteries.
- Bleeding.
- A blood vessel embolism. This happens very rarely when air accidentally enters the sinus, and then into the vessels.
One of the most common complications is collapse. To help the patient in such a situation, it is necessary to tilt him forward. This simple technique allows you to increase pressure by squeezing the abdominal aorta. After the patient is placed horizontally and the lower limbs are raised to increase the flow of venous blood to the heart. If these techniques do not increase blood pressure, caffeine benzoate is injected under the skin.
Consequences of breaking the piercing technique
If during a puncture of the maxillary sinus, the doctor passes the needle in the wrong direction or makes a puncture too deep, damage to the upper or back wall of the sinus may occur.
When the upper wall is punctured, the liquid flows into the orbit. This can lead to the development of inflammation in the tissues of the eye: conjunctivitis, iritis, iridocyclitis, blepharitis. With untimely assistance, vision and eye mobility may deteriorate.
If the doctor had the imprudence to pierce the back wall of the sinus, the needle will fall into the palatine fossa. This will lead to the accumulation of blood inside the facial bone and the formation of a hematoma.
Is the procedure painful?
Many patients who are about to have their maxillary sinus punctured are concerned about pain. Contrary to popular belief, the procedure is completely painless. Possibly an uncomfortable feelingbursting after contact with an antiseptic solution on the mucous membrane. But it passes quickly.
According to reviews, the feeling during the introduction of anesthetic is the same as in dentistry. Due to its use, the pain syndrome is completely eliminated.
A positive attitude plays a big role during the puncture. There is such a thing as the placebo effect. If the patient "winds" himself before the intervention, then during the procedure itself, he may actually be in pain. And all because of self-hypnosis.
Therefore, the doctor before the puncture should tell the patient in detail about all the stages of the procedure in order to calm him down.
Stuffy nose after piercing
The main purpose of a maxillary sinus puncture is to remove or reduce nasal congestion. But there are cases (reviews confirm this) when the condition only worsens. What are the reasons for this paradox?
Firstly, congestion after the procedure may appear as a reflex reaction to the puncture of the mucous membrane, which swells, which prevents a person from breathing. In such cases, the symptom occurs immediately after the intervention. With further therapy, the edema disappears.
Another option is possible when congestion appears after a certain time after the procedure. This indicates a lack of effectiveness. Maybe there are still microorganisms in the sinus. In addition, you need to consider the possibility of the presence of infectious processes nearby. For example, caries in the teeth. Allergic reactions can also cause nasal congestion.
How many punctures are done?
The number of punctures of the maxillary sinus largely depends on the type of procedure (diagnostic or therapeutic). If the procedure is carried out for the purpose of diagnosis and sampling, as a rule, one puncture is enough for this.
At the same time, if drugs are administered during the puncture, usually the course consists of 3-5 punctures.
In today's medicine, the puncture of the maxillary sinus is an emergency method. It is prescribed only if there is a threat of infection spreading beyond the sinus or ineffectiveness of other medicinal methods. With banal sinusitis, oral or parenteral antibiotic therapy is sufficient. And to do a puncture, like other unpleasant procedures (such as "cuckoo"), there is no need.
