Extended middle meatal antrostomy: the treatment of circular flow.

Intranasal surgery has changed significantly over the years. The inferior meatal antrostomy has lost favor to the more physiologic middle meatal antrostomy which includes the natural ostium. Difficult-to-cure patients may exhibit mucous stasis due to circular flow between ostomies. Kennedy described circular flow in both the experimental model and the clinical arena. We have enlarged his definition of circular flow to include the flow of mucus from the natural ostium or a surgically created ostium to any accessory ostium, either natural or surgically created. We present the extended middle meatal antrostomy, a technique which prevents circular flow and allows the mucociliary system to provide for physiologic drainage of the maxillary sinus. This technique is demonstrated in this report to be safe and effective in the treatment of chronic maxillary sinusitis.