Is the balloon a useful tool for revision frontal sinusotomy to efficiently and safely allow subsequent instrumentation of the frontal outflow tract using larger, more aggressive instruments?
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October 2010Background: Reports of drill-out frontal sinusotomy outcomes have emphasized the importance of mucosal preservation and the avoidance of circumferential mucosal disruption in maximizing long-term success. The frontal sinus outlflow tract (FSOT), however, is often not large enough to accommodate instruments other than small curettes.
Study Design: Case report
Setting: Division of Rhinology and Sinus Surgery/Oregon Sinus Center, Oregon Health and Science University
Synopsis: A stepwise technique that first dilates the FSOT using balloon dilation to address the soft stenosis was utilized. The authors reported that nasal endoscopy and CT scan of the sinuses were necessary for proper patient selection. If necessary, endoscopic ethmoidectomy was first performed to clearly visualize the fovea ethmoidalis and lamina papyracea posterior to the frontal outflow tract.
To improve anterior and lateral exposure, excision of residual uncinate was performed. Because scar tissue filling the recess precludes placement of a drill to allow removal of the sinus floor, the authors used balloon dilation of the soft stenosis. A light-transmitting guide wire was inserted and confirmed to be in the correct position, and a 24 mm deflated balloon was advanced over the guide wire (a 3 mm balloon for extremely narrow tracts). The balloon was inflated to 12 times atmospheric pressure, then deflated and removed. The now dilated soft stenosis of the frontal outflow tract enabled clear visualization of the entire drill bit.
Bottom line: The balloon is a useful tool for revision frontal sinusotomy, efficiently and safely allowing subsequent instrumentation of the frontal outflow tract with larger, more aggressive instruments, such as the drill.
Citation: Bhandarkar ND, Smith TL. Revision frontal sinusotomy using stepwise balloon dilation and powered instrumentation. Laryngoscope. 2010; 120(10):2015-2017.
—Reviewed by Sue Pondrom