When surgery is the only option to treat sinus infections’ symptoms, the surgeon can choose from different types of surgeries, such as antrostomy, sphenoidotomy, intranasal or external ethmoidectomy and frontal trephination. However, the antrostomy may cause complications. Injury to nasloacrimal duct may occur. Sphenopalatine artery may bleed.

Surgeons generally fail to envisage the maxillary ostium during maxillary antrostomy. For right positioning of the antrostomy, this visualization is very important.

The antrostomy is suggested for chronic sinus infections’ symptoms that do not heal with traditional antibiotic therapy. Although intranasal antrostomy can be performed via inferior and middle meati, now-a-days the middle meatal antrostomy is preferred.

Intranasal antrostomy, a surgical procedure, creates a channel linking the maxillary sinus and nose via inferior / middle meatus. The channel facilitates drainage and telescopic visualization of the sinus. The antrostomy helps in conducting biopsy of the affected tissues and removing thickened mucosa. General anesthesia is given to the patient prior to the procedure. A wide array of antibiotics is prescribed for up to ten days.

Inferior meatal antrostomy creates an opening in the inferior meatus’ nasoantral wall. Intranasal IMA may be used to treat severe acute rhinosinusitis in children and chronic purulent maxillary sinusitis, but it produces complications. For instance, IMA may damage the nasolacrimal duct. Bleeding may continue even after the operation is complete.

Some medical practitioners still prefer the IMA procedure, while others do not. State-of-the-at techniques shall be used for IMA procedure. For instance, Buiter and Lund suggest that 1*1.5 cm window will ensure that the opening for ventilation and drainage lasts forever. However, the IMA is not done if osteitis is present and in case of polypoidal hypertrophy. 

MMA creates a nasoantral opening to facilitate the antral cavity irrigation. MMA has been performed since late nineteenth century.  During maxillary MMA, the natural ostium of the sinus is cleaned and opened up to restore drainage. In some cases, surgeons also remove polyps, whereas in others surgeons do not remove the polyps. It is surgeon’s discretion. However, antrochoanal polyps must be removed. The antrochoanal polyp begins in the sinus wall and then enters into the nose via the sinus opening. MMA may also cause complications, such as orbit penetrations and sphenopalatine vessel trauma.

Controversies surround both the approaches. However, IMA’s popularity has declined with increase in endoscopic surgeries because performing an IMA with an endoscope is difficult. IMA is less physiological than MMA. If IMA is performed in a professional manner in right time, its results are very good. Post-surgical complications related to IMA are less than that of MMA.