• The paranasal sinuses are large but drainage through the nasomaxillary opening into the middle nasal meatus is through a long, compressed slit and is generally poor.
• The rostral maxillary sinus and ventral conchal sinus have a separate drainage route to the rest of the paranasal sinuses.
• Part of the surgical treatment of paranasal sinus disease may include establishing increased drainage by enlargement or augmentation of the drainage ostia.

Uses

• Establishing drainage into the nasal cavity following surgical treatment of sinusitis Paranasal sinuses: bacterial sinusitis or removal of masses/tumors or diseased teeth Teeth: caries - infundibular cement or damaged/infected mucosa.

Advantages

• Permanently improves paranasal sinus drainage.
• Allows for packing of sinuses with exit out nostril, preventing need to reopen flap to remove packaging.

Disadvantages

• Requires bone flap procedure Paranasal sinus: bone flap technique to gain adequate exposure to establish drainage.
• Often associated with profuse hemorrhage.
• Some cases will have a permanent low grade inflammation of sinuses following this procedure - may have a permanent low grade nasal discharge.

Technical problems

• Distortion of the sinuses from masses Paranasal sinus: cyst: respiratory neoplasia Respiratory: neoplasia may obviate normal architecture and make fenestration of the rostral portion of the ventral conchal sinus difficult.
• Fenestration of the ventral conchal sinus is uncomfortable and may result in patient non-compliance if performed standing.

Alternative techniques

• Lavage of sinuses Paranasal sinus: lavage: in acute cases simple lavage may improve the drainage by liquifying the material in the sinus and forcing it out through the normal ostia - less effective in chronic cases where persistent production of material, often of a thickened nature.
• Lavage + ostia enlargement usually undertaken at same time.
• Feeding from ground/exercise: useful in acute cases of sinusitis but limited effect in chronic case.

Time required

Preparation

• Aseptic skin preparation: 10 min.
• General anesthesia induction and maintenance: 20 min.

Procedure

• Preparation of flap, entry into sinuses and closure: 45-60 min Paranasal sinus: bone flap technique.
• Establish drainage: 10-20 min.

Decision taking

Criteria for choosing test

• Drainage may be warranted in any case of paranasal sinus disease which is subjected to surgical treatment.

Risk assessment

• Sino-nasal surgery can → severe blood loss → anesthetic risk Anesthesia: general - overview and may require transfusion Blood: transfusion.