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Endoscopic Frontal sinuplasty

Introduction:  This procedure was first introduced at the American Academy of Otolaryngologists in

September 2005.  This is infact the least invasive of all frontal sinus surgical procedures.   This procedure involves introduction of a Balloon catheter into the frontal sinus outflow tract and dilatation of the balloon.  When inflated this balloon widens the frontal sinus outflow tract in a least traumatic way.  This dilatation does not affect the mucociliary clearance mechanism of the sinus outflow tract mucosa.  Dilatation of the balloon pushes the medial wall of agger nasi cell laterally and the Bulla ethmoidalis posteriorly.  The inflating balloon does not crush the agger nasi cell completely thereby reducing the incidence of post operative obstruction to frontal sinus drainage pathway.

Indications:

1.       Management of isolated frontal sinus disease not responding to medical management

2.       Can be used in conjunction with sinuplasty of maxillary and sphenoid sinuses

3.       Can be used in combination with endoscopic  ethmoidectomy as a hybrid procedure

4.       It can be used to effectively identify frontal sinus ostium

Procedure:

Instruments needed:

1.       Angled endoscopes 30⁰ and 70⁰.  These scopes will enable visualization of frontal sinus drainage tract

2.       Balloon catheter and guide wire

3.       Curved ball probe

4.       Image intensifier

After anesthetizing and decongesting the nasal mucosa the guide wire is introduced into the frontal recess area.  If there is resistance then its position can be verified using an image intensifier.  If the passage is smooth the balloon catheter can be rail roaded over the guide wire.  After removing the guide wire, the balloon is inflated by pushing in air after checking its position using image intensifier.   On inflation the ends of the balloon fills first because the natural ostium creates a pinching effect in the middle.  On increasing pressure the bone around the ostium fractures causing expansion of the bulb.  This causes a dilatation of the ostium.  Usually 4-6 atmospheres of pressure may be reached on inflating the balloon.  
 
 
Balloon catheter in position
 
 
Balloon being inflated
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