Indications

• An infundibulotomy as a sole procedure is done for isolated purulent maxillary sinusitis.

• An infundibulotomy is the key first step in most procedures for chronic rhinosinusitis.

• Join accessory anterior or posterior fontanelles as they are said to run the risk of producing a circular motion of mucus from one ostium to the other, thus providing a never-ending cycle that is prone to infection (Fig. 5.6a-c).

• In cystic fibrosis, a wide ostium may help local irrigation and the mechanical clearance of retained secretions.

• There is some evidence that a type II maxillary sinusotomy helps atopic patients as a type I maxillary sinusotomy is prone to closing from mucosal hypertrophy (Davis et al., 1991).

• If there is maxillary sinus pathology that requires more access (type III maxillary sinusotomy): e.g., an antrochoanal polyp, where it is important to remove the base of the retention cyst, otherwise it will reform.

• A mycetoma (Fig. 5.7a, b), foreign body, or persistent maxillary sinus problems secondary to dental problems that have received treatment, and also in polypoid maxillary disease.

• If there are extensive polyps within the maxillary sinus we would recommend using a microdebrider or through-cutting forceps to debulk these and not to strip the mucosa as to remove it would result in healing by secondary intention with long-term crusting or pooling of pus.

• In patients who are to undergo extensive ethmoid surgery or surgery geared to improving their sense of smell, it is necessary to open the maxillary ostium inferiorly so that when the middle turbinate is lateralized to open the olfactory cleft it is still possible for the sinus to drain and for the surgeon to obtain access to be able to inspect it (Fig. 5.8a, b). Note that in patients who need to have their olfactory cleft opened, the maxillary sinusotomy should extend below the inferior edge of the middle turbinate so that it remains patent.

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