If the turbinate is noted to have shifted during a postop checkup, it can be gently nudged back in place with the placement of a spacer to hold it over while it heals, Dr. Sindwani said.
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July 2007Future Look
Generally, the frontal sinus is the toughest to keep open and is commonly associated with recurrent trouble. In stubborn cases, stents are sometimes used. However, there is controversy as to how long they should stay in and they can be associated with their own sets of problems, Dr. Sindawani said.
Dr. Friedman agreed that stents are tricky. On the one hand they prevent scarring or restenosis. But it’s a foreign body and the stent itself can become obstructed with mucus, he said.
An alternative now being studied in Dr. Friedman’s center is the use of balloon sinusplasty for patients with postoperative scarring. A microdebrider is used to clear some space, then with the use of fluorososcopy, a small wire is threaded into place. The balloon is placed over the wire, then inflated under high pressure. The ostium is stretched open instead of being cut, he said.
Initial clinical studies show that the technique is easy, with low morbidity. I think this is something for the future for patients with frontal sinus scarring and sphenoid sinus scarring, and possibly, to a lesser extent, maxillary sinus scarring, he said.
Dr. Sindwani cautioned that balloon sinuplasty has not been studied rigorously enough to endorse yet. When it comes to keeping the frontal sinus open, which indeed can be tough. Balloons used to open this area more than likely is enlarging the frontal recess (the area just below the frontal opening), rather than the true opening itself, he said.
Overall, the best way to avoid RESS is to use meticulous surgical technique and avoid inadvertent tissue trauma in critical and unforgiving areas like the frontal and sphenoid sinuses, Dr. Sindwani said.
©2007 The Triological Society
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