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CHRONIC SINUSITES                                   73

Apart from affording information on the state of the sinuses radiography
will show deviations of the bony nasal septum, and the degree of nasal
congestion may be estimated from the translucency of the nasal cavities.

Proof Puncture. As its name implies this is a puncture of the maxillary sinus
to prove or disprove that a radiographically opaque sinus contains infected
material. It is performed as a rule under local cocaine anaesthesia in adults but
under general anaesthesia in children or nervous adults. The antrum is
punctured through the inferior meatus by a trocar and cannula, the needle
being inserted near the roof of the meatus where the antral wall is thin

Fig. 32. Proof puncture of the right maxillary sinus.

(Fig. 32). On entering the antrum the trocar is withdrawn leaving the cannula
in the sinus. A blunt pointed needle attached to a syringe containing 3 ml of
sterile normal saline is passed through the cannula, the needle being of
sufficient length to project beyond the tip of the cannula. The saline is
injected into the sinus and slowly re-aspirated into the syringe and the contents
inspected. If pus is found it can only have come from the sinus and it is sent
for culture and sensitivity tests.

Some surgeons then remove the syringe and needle and pass a polythene
tube through the cannula which is then withdrawn and the tubing is fixed to
the cheek by adhesive tape. This tube may be used for lavage of the sinus or
for instilling antibiotic solution into the sinus.

Antral Lavage. Antral lavage is an extension of the proof puncture. If
mucopus is obtained at proof puncture the needle is withdrawn and a
Higginson's syringe is attached to the cannula. The sinus is then washed
through with a warm sterile solution of normal saline. This fluid will enter the
nasal cavity if the ostium is patent and the flow is caught in a receiver held
under the patient's nose. Some surgeons do not perform a preliminary
aspiration but wash out the sinus immediately after puncture. It is important