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A Hybrid Approach: Balloon Sinuplasty & FESS

The frontal sinus outflow tract is one of most common sites of obstruction leading to chronic rhinosinusitis (CRS). The anatomy of the frontal recess is complex, compounded by a high degree of inter-individual anatomic variability. The location of the frontal sinus, between the anterior skull base and the orbits, makes endonasal access challenging.1 Additionally, the disease most often recurs in the frontal recess post-FESS (Functional Endoscopic Sinus Surgery); this is said to be due to endoscopic bone removal resulting in tissue trauma and inflammation along with a resultant increase in risk of stenosis due to mucosal disruption.2 The narrow boundaries of the frontal sinus tract also increase the potential for injury to the cribriform plate, ethmoid skull base and the orbit.1

However, balloon dilation in combination with standard frontal sinus dissection techniques, may lessen the concerns of removing bone and mucosa. It also allows for enlargement of narrow, difficult-to-access areas and increases access for endoscopic instruments1

One such case which was conducted in Hyderabad. A 71 year lady presented with CRS involving the bilateral maxillary, frontal and ethmoidal sinuses along with bilateral sinonasal polyposis. Due to failure of medical management and limited mucosal disease in the frontal sinuses it was decided that she would undergo a hybrid procedure which involved FESS as well as a balloon sinuplasty. FESS was carried out involving bilateral middle meatal antrostomy and conventional ethmoidectomy. The balloon sinuplasty procedure was carried out for the frontal sinuses which demonstrated minimal mucosal thickening. (Click here to watch the procedure)

In conclusion, balloon dilation, in combination with FESS may be beneficial for patients with sinonasal polyposis where there is limited mucosa disease involving the frontal sinuses.

 

References

1.Fleischman GM, Miller JD, Kim GG, Zanation AM, Ebert CS. Treatment of chronic frontal sinusitis with difficult anatomy: A hybrid balloon technique in four cases. Allergy & Rhinology. 2014;5(3):e120-e124. doi:10.2500/ar.2014.5.0096.

2.Kennedy DW, Senior BA. Endoscopic sinus surgery: A review. Prim Care 25:703–720, 1998.

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