The use of a telescope in sinus balloon dilation.

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Balloon catheter dilation is being used to help improve paranasal sinus ventilation. (1,2) Those who teach the technique emphasize the use of the C-arm fluoroscope and the tactile introduction of a sinus guidewire. This is followed by the insertion of the sinus balloon catheter over the sinus guidewire. The balloon is inflated, deflated, and withdrawn. All of this can usually be accomplished without the use of a sinus telescope. However, we have found that the use of a telescope in addition to fluoroscopy is quite helpful (figure, A). (3)

Our technique starts with the endoscopic identification of the entrance to the involved sinus (in the case illustrated here, the sphenoid sinus) (figure, B). The sinus guide cannula is placed endoscopically near this entrance (figure, C). The sinus guidewire is then inserted through the sinus guide cannula and visually inserted into the sinus entrance with the aid of a 0[degree] 4-mm telescope (figure, D). The sinus balloon catheter is then inserted over the sinus guidewire and placed in position visually (figure, E). The position can be confirmed with the fluoroscope to ensure that the distal radiopaque marker is in the sinus and the proximal marker is external to the sinus entrance. The balloon is then inflated to the desired pressure and left inflated for 5 to 10 seconds. The proximal portion of the inflated balloon's position can be confirmed and visualized external to the sinus entrance with the 0[degree] telescope (figure, F).

The balloon is then deflated. Deflation is confirmed via telescopic visualization prior to withdrawal (figure, G). The dilated sinus entrance is then visually inspected with the 0[degree] telescope (figure, H). In the case illustrated here, the sinus balloon dilation of the sphenoid ostium allowed for visualization of the optic nerve, an infraoptic recess, and a prominent carotid artery (figure, I).

The use of frequent telescopic visualization allows the surgeon to confirm what is occurring fluoroscopically and tactilely. Specifically, the surgeon can confirm the location of the sinus guide cannula, the guidewire entrance, and the sinus balloon catheter entrance into the sinus. The surgeon can also confirm the position of the proximal portion of the inflated balloon and the fact that the balloon has been deflated prior to removal. Finally, and of great importance, the physician can inspect the result of the dilation.

The use of telescopic visualization with fluoroscopy gives a set of checks and balances to sinus catheter balloon dilation.

References

(1.) Brown CL, Bolger WE. Safety and feasibility of balloon catheter dilation of paranasal sinus ostia: A preliminary investigation. Ann Otol Rhinol Laryngol2006;115(4):293-9; discussion 300-1.

(2.) Bolger WE, Vaughan WC. Catheter-based dilation of the sinus ostia: Initial safety and feasibility analysis in a cadaver model. Am J Rhinol 2006;20(3):290-4.

(3.) Christmas DA, Mirante JP, Yanagisawa E. Endoscopic view of balloon catheter dilation of sinus ostia (balloon sinuplasty). Ear Nose Throat J 2006;85(11):698,700.

Dewey A. Christmas Jr., MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS

From the Department of Otolaryngology, University of South Florida College of Medicine, Tampa, and the Halifax Medical Center, Daytona Beach, Fla. (Dr. Christmas and Dr. Mirante), and the Southern New England Ear, Nose, Throat, and Facial Plastic Surgery Group; the Section of Otolaryngology, Hospital of St. Raphael; and the Section of Otolaryngology, Yale University School of Medicine, New Haven, Conn. (Dr. Yanagisawa).