With a disease of maxillary sinusitis, complex drug therapy is required, aimed at suppressing pathogens and eliminating the symptoms of the disease. Often, conservative methods do not give the desired effect; in such cases, the attending physician prescribes a puncture of the maxillary sinus. There are legends about this procedure among patients, they are afraid of it and try to avoid it by any means. It is necessary to dwell in more detail on what kind of treatment method it is and whether it hurts to make a puncture with sinusitis.
What is a puncture and when is it prescribed
With sinusitis, the mucous membranes of the nasal paranasal chambers are exposed to viruses (at the initial stage) and pathogenic bacteria (during the development of the disease). In this case, severe swelling of the tissues of the maxillary sinuses and the nasal cavity develops. The narrow connective fistula is partially or completely blocked, due to which purulent exudate is not excreted, accumulates in the voids and complicates the course of the disease. This situation can threaten the spread of infected mucus to neighboring organs and the development of complications that pose a danger to human life.
If it is not possible to remove the edema with antibiotics and rinsing, then in such cases it is necessary to evacuate the collected mucus forcibly. The most suitable and time-tested method is a puncture of the maxillary sinus. In this case, the thin walls of the nasal sinuses are pierced with a needle, the contents are sucked off with a syringe and the necessary drugs are injected.
The indications for the appointment of a puncture with sinusitis are the following factors:
- A severe condition of the patient, which is expressed in a severe pain syndrome localized in the air sinuses or covering different parts of the head, provided that the pain cannot be alleviated with the use of medications.
- Complete obstruction of the connecting canal due to edema or mechanical obstruction (cyst, polyp). This is evidenced by severe bursting pains in the region of the maxillary sinuses.
- Lack of positive dynamics as a result of conservative treatment and physiotherapy, usually within 6-7 days.
- High temperature (more than 38 degrees) for a long time and the development of general intoxication of the body.
- The presence of blood or a horizontal level of secretion in the air cavity, which is confirmed by the results of X-ray or computed tomography.
- Odontogenic sinusitis, for the treatment of which
a puncture is required. An unpleasant smell from the nose is evidence of this form of the disease.
a puncture is required. An unpleasant smell from the nose is evidence of this form of the disease.Also, a puncture of sinusitis is performed in cases that are difficult to diagnose and make a correct diagnosis. In this case, it is necessary to pierce the sinuses of the nose and take the contents (scraping) for bacteriological analysis to accurately determine the pathogen. Puncture of sinusitis is also used to introduce a contrast element into the cavity in order to obtain the highest quality image during X-ray examination or computed tomography.
How the operation is carried out, its main stages
A puncture of the nose with sinusitis is carried out in the treatment room of the hospital by an otolaryngologist. There is no need to constantly be in the hospital in the absence of special indications, you can be treated on an outpatient basis and appear for manipulations as prescribed by a doctor. The procedure can be used in the treatment of adults and children, however, punctures are prescribed for small children only in the most severe cases and are carried out under general anesthesia in a hospital. The operation itself consists of several successive stages.
Anemization. In order to make the operation field more visible and convenient for manipulation, a vasoconstrictor drug (oxymetazoline) is injected into the nasal passages 10-15 minutes before the start, or turundas soaked in adrenaline are inserted. This relieves tissue swelling and makes the mucous membrane more susceptible to pain relief.
Anesthesia. Puncture for sinusitis is not the most pleasant procedure, so it is always done under local anesthesia. Before starting anesthesia, the nurse should test the patient's tolerance to the agent to be anesthetized. Otherwise, if the patient has an intolerance to this drug, anaphylactic shock is possible.
Today, 2 types of pain relief are used:
- Infiltration. The pain reliever is given through a shot.
- Surface (terminal). It is used more often and consists in the introduction for 7-10 minutes into the nasal passage on a special long spatula or turunda wire dipped in anesthetic. Sometimes a special cream is applied to the skin.
Common anesthetics are used for pain relief, such as:
- lidocaine;
- novocaine;
- trimecaine;
- tetracaine.
Before the puncture, the doctor must check whether the anesthetic has worked well enough, and, if necessary, will introduce an additional dose of the drug. General anesthesia is rarely used, usually in the case of complications that may complicate the operation.
Puncture. After carrying out all the preparatory actions, the doctor proceeds to the actual puncture. In this case, the patient sits on a stool or chair. For manipulation, a thick-walled hollow Kulikovsky needle is used, the tip of which is curved, and the back part is equipped with a cannula for attaching a syringe. The doctor inserts the needle through the nasal passage to the thinnest place of the medial wall of the maxillary sinus, and, with moderate pressure, pierces it until it sinks. The needle should go 1-1.5 cm inside the chamber.
Washing the maxillary sinuses... When the curved tip of the needle is inside the cavity, a syringe is connected to the cannula, with which an antiseptic solution is injected, and the liquefied mucopurulent accumulations are sucked off. If you need to accurately determine the causative agent of the disease, then part of the exudate is sent to the laboratory for bacterial inoculation. Then a syringe is injected into the sinus with a medicinal solution, which, depending on the cause and degree of development of the disease, may include antibiotics, antiseptics, mucolytics or antifungal agents. Often, the ENT doctor leaves a catheter in the hole, which had to be punched, through it, medications are periodically delivered to the accessory chamber and rinses are performed. Such a catheter can stand for several days.
The entire operation, excluding the preparatory period for anemization and anesthesia, usually lasts no more than 5 minutes. There is nothing particularly complicated in it, therefore, practically any more or less intelligent otolaryngologist can perform it qualitatively. Complications during puncture are relatively rare and are expressed in the following manifestations:
- small and large bleeding;
- accidental puncture of the back or upper wall of the sinus;
- lowering blood pressure, shock, fainting due to the fear of the patient.
Most often, complications are associated with a human factor (doctor's mistake, inappropriate patient behavior) or with the individual structural features of the accessory chamber, which could not be seen on an x-ray.
As a rule, one minimally invasive intervention cannot get rid of sinusitis. If the patient is not all the time in the hospital with a catheter inserted into the hole for washing, the doctor punches the sinus 2-3 times or more to completely cleanse it of pus and eliminate the focus of inflammation. This allows you to dramatically speed up the healing process and prevent the chronicity of the disease.
Contraindications for puncture
Puncture of the maxillary sinus is not shown to everyone.There are circumstances under which this procedure is contraindicated. These include:
- the presence of an infectious process in the acute stage;
- congenital developmental disorders of the maxillary sinuses or nasal cavity;
- hypoplasia of the accessory chambers;
- chronic diseases in severe forms (hypertension, diabetes mellitus);
- infancy.
In addition to the presence of direct contraindications, a good doctor always pays attention to the general condition of the patient, whether he has any individual characteristics and his readiness for the procedure, including psychological. Sometimes it is better to try to apply such methods as "cuckoo" lavage or Yamik catheter in combination with antibiotic therapy, and only in the absence of positive dynamics to offer a sinus puncture. However, when deciding whether to make a puncture, you need to rely more on the opinion of a specialist than on your desires.
How painful the puncture is
While there are many horror stories that a puncture is a terribly painful operation, it should be noted that a puncture is a minimally invasive intervention. Real operations, involving a full opening of the maxillary cavity to clean it, are rarely performed and only in the most severe advanced cases, when it threatens the patient's life.
If we talk about pain, then they are not at all as strong as they say about it. Most of the search queries like "puncture sinusitis" or "puncture sinusitis" are entered precisely in order to find out how painful this operation is. In fact, after anesthesia, there is practically no pain syndrome. Patients are more frightened by the loud crunch when piercing the sinuses with sinusitis. This sound seems to be very loud largely due to the fact that it is heard "from the inside" and is transmitted to the hearing organs not so much in the form of sound vibrations as through the resonance of bone tissue.
In addition, the patient sees a large needle and all the actions of the otolaryngologist, which leads to increased excitement and a sense of fear. This can be dealt with by taking any sedative 30 minutes before surgery.
If a child is undergoing surgery, it is advisable that the parents are there and reassure him, setting him up in a positive mood.
As for the punctured bone wall of the sinus, the rumors that a huge hole will forever remain at the puncture site are absolutely groundless. Human bone tissue has enormous resources for recovery. Special osteoblast cells actively synthesize the building material of bones (bone matrix), so the hole is overgrown very quickly.
Treatment of sinusitis after surgery and prevention of the disease
In defense of the method under consideration, it is evidenced that the treatment of sinusitis with a puncture is a very effective way to quickly overcome the disease. For positive dynamics in use 
drug therapy, various irrigations of the nose and the use of traditional methods, it is necessary for a fairly long time, sometimes several weeks. Surgical intervention allows you to relieve the most severe manifestations of the disease within 1-2 days, such as headaches, lack of nasal breathing, intoxication of the body from the presence of purulent secretions inside the air cavities. Often, the otolaryngologist will send the patient for a second X-ray to confirm the success of the treatment.
Sinusitis after a puncture is treated with antibiotics and other medications. At the same time, the main attention is paid to the removal of swelling of the tissues of the nasal cavity, the restoration of full breathing through the nose, and regular cleansing of the nasal passages from mucus. At the recovery stage, in agreement with the doctor, traditional medicine is widely used, most often washing with decoctions of herbs. It is important not to interrupt treatment when the patient's condition improves, so that bacteria do not develop resistance to the antibiotics used, and also so that the disease does not become chronic.
In the future, a number of measures should be taken to prevent the disease:
- regularly rinse your nose with saline solutions to prevent drying out of the epithelium, and also drink more liquid (teas, compotes, juices);
- use household humidifiers in the apartment;
- try to avoid substances with strong odors (varnishes, paints, cigarette smoke);
- less being outdoors during the flowering period of plants with an allergic effect;
- treat colds at an early stage;
- regularly visit the dentist for consultations;
- do not swim in chlorinated pools and ponds with cold water;
- to strengthen the general immunity (proper nutrition, regular physical activity, vitamins and mineral complexes).
