What is the optimal maxillary antrostomy size during sinus surgery?

PURPOSE OF REVIEW: To review all the journal articles relevant to chronic maxillary sinusitis in order to discuss the optimal size of maxillary antrostomy during endoscopic sinus surgery. RECENT FINDINGS: Although endoscopic maxillary antrostomy is a longstanding and frequently performed procedure, there is limited evidence about the optimal size of the antrostomy. Commonly employed surgical options include dilation via balloon sinuplasty, traditional antrostomy with uncinectomy using forceps and powered microdebriders, enlargement of the natural ostium, and the mega-antrostomy or modified medial maxillectomy. Historically, inferior antrostomies or nasal-antral windows were commonly utilized in the preendoscopic era, although this procedure is less commonly used today. SUMMARY: Balloon sinuplasty can be effective in dilating the ethmoid infundibulum and natural ostium for select patients with isolated maxillary sinusitis or mild disease. A standard antrostomy using biting forceps and powered instrumentation is more appropriate for advanced disease such as severe mucosal hyperplasia or nasal polyps, as it allows for visualization of the maxillary sinus cavity and more effective topical delivery of saline irrigations and medications. For recalcitrant maxillary sinusitis, the mega-antrostomy allows for gravity-dependent drainage and is most appropriate for patients with inherent mucociliary defects.