Puncture of the maxillary sinus is a procedure that is performed by an otorhinolaryngologist for a diagnostic or therapeutic purpose. It helps to determine the severity of the pathological process, as well as changes in the dynamics. In addition, this intervention facilitates the patient's condition.
Indications for the procedure
Puncture of the maxillary sinus is not prescribed to absolutely all patients with problems of the otorhinolaryngological nature. It is carried out only after a thorough examination. First, the doctor must collect an anamnesis, conduct an objective examination. Then he prescribes non-invasive diagnostic methods, that is, those that do not require damage to the skin, as a puncture.
Diagnostic puncture of the maxillary sinus is performed only in those cases when, after carrying out all the above methods, any ambiguities remain. But medical puncture is done in order to alleviate symptoms 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;
- the accumulation of a large amount of pus in the sinus;
- to examine the contents of the maxillary sinus cyst;
- taking a biopsy for examination under a microscope if an oncological process is suspected;
- for therapeutic purposes, puncture is carried out with the ineffectiveness of drug therapy and in the presence of bacterial inflammation in the maxillary sinus.
Technique of the procedure: first stage
Before the puncture, the nasal mucosa is treated with an anesthetic solution. This is necessary to prevent pain. To expand the vessels and sinus excretory duct, an adrenaline solution is administered to the patient. Puncture of the maxillary sinus is carried out through the lower nasal passage.
A needle is used for puncture, the end of which is bent. If this is not available, then the use of a needle for lumbar puncture is allowed. The doctor carefully 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. Here the bone is the thinnest, so the puncture is easiest to make.
After this, 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 tool displacement and damage to the walls of the sinus. It is allowed to change the injection site if the initially selected location is not sufficiently malleable.
The subsequent stages of the procedure
The next stage of the technique of puncture of the maxillary sinus is a check of patency of the anastomosis. Further medical tactics depend on its results. If the piston of the syringe extends easily and after it does not come back, then the anastomosis is passable. Another sign of patency is that sinus fluid flows freely into the nasal cavity. In this case, it is necessary to carefully remove the fluid in the sinus.
Next, the doctor rinses the sinus with antiseptic solutions. The patient's head is tilted down and forward. A tray is placed under the patient’s head where fluid is collected. This position prevents it from entering the pharynx or upper respiratory tract.
If necessary, at this stage, a puncture of the maxillary sinus can be performed with the introduction of drugs. In this case, doctors administer antibiotics, proteolytic enzymes.
If it was found that the anastomosis is impassable, the doctor makes another puncture. The sinus is flushed through two needles.
The fluid obtained by puncture is collected in a sterile tube and sent for analysis to the laboratory.
If the punctures are performed regularly, a catheter is inserted into the opening in the nasal passage. Further punctures are already done through this tube. This method deprives the doctor of the need to make a new puncture every time.
Contraindications to the procedure
Medical and diagnostic puncture of the maxillary sinus, like any other study, has a number of contraindications.
This procedure is prohibited for young children, as their sinuses are not yet as developed as in adults.
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 need to limit as much as possible any invasive interventions, as this can lead to a worsening of their condition.
People with mental disorders are also prohibited from this procedure.
Separately, a group of patients is identified who simply cannot perform a sinus puncture. This may be due to a thick bone wall or the presence of pathology of its development.
Complications after the procedure
Complications of a puncture of the maxillary sinus is a rarity. However, sometimes they do happen. The occurrence of such unwanted effects is possible:
- A sharp decrease in blood pressure, or collapse. This is manifested by marble pallor, blue lips. Perhaps clouding of consciousness.
- A common purulent inflammation of the orbit - phlegmon. Appears due to ingestion of pus from the sinus.
- Damage to the cheek tissue with a needle.
- Infectious infection of the blood, or sepsis. It occurs when bacteria enter the sinus into the bloodstream.
- Soft tissue hematoma due to damage to arteries.
- Bleeding.
- Blood vessel embolism. This happens very rarely with accidental penetration of air into 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 laid 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 a violation of the puncture technique
If the doctor draws the needle in the wrong direction or punctures too deep during a puncture of the maxillary sinus, damage to the upper or back wall of the sinus can occur.
When the upper wall is punctured, the fluid flows into the orbit. This can lead to the development of inflammation in the tissues of the eye: conjunctivitis, iritis, iridocyclitis, blepharitis. If untimely assistance is provided, vision and mobility of the eye may be impaired.
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 have a maxillary sinus puncture are concerned about its soreness. Contrary to popular belief, the procedure is completely painless. Perhaps an unpleasant sensation of bursting after getting an antiseptic solution on the mucous membrane. But it passes quickly.
According to reviews, the feeling with the introduction of anesthetic is the same as in dentistry. Due to its use, the pain syndrome is completely eliminated.
An important role in conducting a puncture is played by a positive attitude. There is such a thing as the placebo effect. If the patient "winds up" himself before the intervention, then during the procedure itself it can actually be painful. And all because of auto-suggestion.
Therefore, the doctor before the puncture should tell the patient in detail about all stages of the procedure in order to reassure him.
Nasal congestion after puncture
The main purpose of the 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 can appear as a reflex reaction to a puncture of the mucosa, 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 its lack of effectiveness. Maybe in the bosom there are still microorganisms. In addition, it is necessary to consider the possibility of the presence of infectious processes nearby. For example, tooth decay. Allergic reactions can also trigger 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 taking material, as a rule, one puncture is enough for this.
At the same time, if drugs are injected during the puncture, usually the course consists of 3-5 punctures.
In today's medicine, maxillary sinus puncture is an emergency method. It is prescribed only if there is a threat of spread of the infection beyond the sinus or the ineffectiveness of other medicinal methods. With banal sinusitis, therapy with an oral or parenteral antibiotic is sufficient. And to make a puncture, like other unpleasant procedures (such as a "cuckoo"), there is no need.