Bilateral endoscopic maxillary antrostomy (anesthesia and hospitalization costs not included)

Bilateral Endoscopic Maxillary Antrostomy is a minimally invasive surgical procedure performed through the nasal cavities with the aim of creating or enlarging the natural openings (ostia) of both maxillary sinuses. This procedure enables efficient drainage and ventilation of both sinuses and is indicated in cases of bilateral chronic sinusitis, sinonasal polyposis, or other conditions that are resistant to medical treatment.

Maxillary Sinuses the maxillary sinuses are the largest of the paranasal sinuses, located in the maxillary bones on either side of the nose. Their functions include: reducing the weight of the skull, humidifying and warming inhaled air, influencing vocal resonance, draining secretions through their natural ostia into the nasal cavities.
Bilateral blockage of these ostia can lead to mucus buildup, inflammation, and recurrent infections.

The surgery is performed under general anesthesia. Using a nasal endoscope and microsurgical instruments, the surgeon creates or enlarges the ostia of both maxillary sinuses. During the procedure, purulent secretions, inflamed tissue, cysts, polyps, or other pathological formations are removed. If suspicious lesions are encountered, biopsy may be performed.

The major advantage of the endoscopic technique is the high visual precision and absence of external incisions. The procedure is generally well tolerated and usually does not require postoperative nasal packing.

Objectives of the Procedure

• Restore drainage and ventilation of both maxillary sinuses
• Reduce inflammation and facial pressure symptoms
• Prevent recurrences of chronic bilateral sinusitis
• Improve the effectiveness of local treatments (sprays, nasal irrigation)
• Avoid traditional open surgery

Indications

• Chronic bilateral maxillary sinusitis
• Ethmoid-maxillary polyposis
• Bilateral cysts, mucoceles, or retention lesions
• Refractory recurrent sinusitis
• Presence of foreign bodies or fungal mycelia in both sinuses
• Bilateral access for biopsy, drainage, or removal of tumorous formations

Contraindications

• Blood coagulation disorders
• Acute upper respiratory infections
• Fever
• Severe decompensated systemic diseases

Preoperative Preparation

Before surgery, a complete medical evaluation is required to confirm the diagnosis, define the surgical indication, and minimize postoperative risks:

• ENT consultation with nasal endoscopy
• CT scan of the paranasal sinuses
• Fasting for at least 6 hours before the procedure (if general anesthesia is used)
• Temporary discontinuation of anticoagulant medication, as advised by the physician

Procedure duration: 30–45 minutes

Recovery time: 1–2 weeks; full mucosal healing: approx. 1 month

Postoperative effects: Mild swelling or discomfort may occur in the first few days.
Follow-up: A medical check-up is recommended 1–2 weeks after the procedure

Bilateral endoscopic antrostomy is a safe and effective method, widely used in the treatment of extensive chronic sinusitis. It is the first-line surgical option in European clinical guidelines, preferred over classical methods due to minimal trauma, shorter recovery time, and durable functional outcomes.