Inferior meatal antrostomy. Fundamental considerations of design and function

The operation of inferior meatal antrostomy has emerged as the most popular surgical technique in the management of maxillary sinusitis though the surgical anatomy and natural history of the procedure are poorly understood. The anatomy of the inferior meatus determines surgical limitations and a retrospective study of 108 patients who have undergone antrostomy provides a basis for a prospective study in which the size of the antrostomy has been assessed in 65 patients pre- and post-operatively using direct measurement and serial photography. After initial circumferential healing within the first few weeks, the majority remain unchanged unless infection supervenes when complete closure may result. The closure is a combination of fibrous tissue and bone in the majority of cases. A critical size is apparent below which complete closure can be anticipated whereas if too large an antrostomy is fashioned, related anatomy is jeopardized and therefore the dimensions must be carefully judged if long-term patency is desired. The effect of patency on the mucus-secreting elements of sinus mucosa is examined in a second prospective group of 19 patients. Assessment of subjective clinical success determines overall benefit from the operation in most patients though mucous discharge is least improved and this is directly related to the level of increase in goblet cells. The role of the inferior meatal antrostomy is dependent upon an understanding of the pathophysiology of sinusitis and thereby determining those patients who have potentially reversible mucosal damage and are therefore most likely to benefit from the procedure.