Sinuplasty (procedure)
Encyclopedia
Balloon sinuplasty is an endoscopic surgical procedure for the treatment of blocked nasal sinuses. Patients diagnosed with chronic sinusitis but not responding well to medications may be candidates for some type of sinus surgery. Two options are balloon sinuplasty and functional endoscopic sinus surgery
(FESS).
Balloon sinuplasty is an endoscopic, catheter
-based system for patients suffering from sinusitis. The procedure has been cleared by the U.S. Food and Drug Administration. It uses a small, flexible balloon catheter to enlarge sinus passageways. When the balloon is inflated, it widens the walls of the sinus passageway, with the goal of restoring normal sinus drainage without damaging the sinus lining.
When performing Balloon Sinuplasty, the physician inserts a sinus guide catheter through the nostril to gain access to the sinus ostia (opening) under endoscopic visualization. The endoscope allows the physician to see through the nasal passages to the sinus cavities to ensure that he/she is inserting the catheter into the proper location. A sinus guide wire or sinus illumination system is then introduced into the targeted sinus via the sinus guide catheter. The sinus illumination system provides a targeted fiber optic light transmission that helps the physician place the sinus guide catheter in the correct place. When the Balloon Sinuplasty system was introduced in 2005, illuminated wires did not exist and surgeons confirmed the location of the wires with low level xray using flouroscopy.
Once access to the intended location is confirmed by light or flouroscopy, a balloon catheter is introduced into the sinus cavity over the sinus guide wire or sinus illumination system and positioned in the blocked ostium for inflation. Once the position has been confirmed visually, the balloon is inflated to unblock the narrow or blocked ostium. The balloon is then deflated and removed. Next, an irrigation catheter may be advanced over the sinus guide wire or sinus illumination system to flush out the sinus of any mucus or pus. Finally, the sinus irrigation catheter is removed from the sinus to allow the sinus cavity to drain any mucus and/or pus. Newer balloon cathers have the irrigation system incorporated into the balloon making the procedure simpler with fewer steps.
, and was brought to market in 2005, after FDA approval. Patients with sinus disease in the maxillary sinus (under the cheek), frontal sinus (over the eyes), and sphenoid sinus (in the middle of the head) and caused by obstruction can benefit from Balloon Sinuplasty. Balloon Sinuplasty technology is not used in the ethmoid sinuses (between the eyes). Balloon Sinuplasty can be used alone to manage disease in the frontal, maxillary or sphenoid sinuses. It can be combined with traditional sinus technologies to manage disease in the maxillary, frontal and/or sphenoid sinus when there is disease in the ethmoid sinus (hybrid procedure). Once the sinus is open, a culture of the mucus can be obtained with an irrigating catheter to test for specific bacteria and/or fungus. Balloon procedures alone may offer adequate visualization to insert tools to obtain biopsies, however,if it does not, a hybrid procedure can be perfomred to offer the surgeon the ability to send biopsy material for examination under the pathologist's microscope in order to rule out cancer or other important diseases that may be found in the sinuses. When performed as an isolated procedure, Balloon Sinuplasty has a high safety record. When combined as a hybrid procedure, there is a small risk of damage to the brain and eyes because of the performance of the traditional operation.
Just like traditional surgery, for those patients who have infection in the bone of the sinuses (osteitis), hybrid Balloon Sinuplasty surgery may be needed followed by long term antibiotics given by mouth or intravenously. Since Balloon Sinuplasty permits surgical management of the sinus disease with preservation of tissue and rarely requires packing, return to normal activities may occur earlier than traditional sinus surgical procedures. As with any sinus surgery, Balloon Sinuplasty or traditional surgery, additional treatment medically or surgically may be needed depending the cause of the sinus disease. .
2. Bolger, WE, et al.; Catheter Based Dilation of the Sinus Ostia: Initial Safety and Feasibility Analysis in a Cadaver Model; American Journal of Rhinology May-June 2006, Vol. 20, No. 3, P. 290-294
3. Benninger, M., Otolaryngology Head and Neck Surgery 2003; 129S: s1-S32
4. Gliklich, R., et al., Journal of Allergy Clin Immunol 1999; 113: 104-109
5. Ray, N., et al., Journal of Allergy Clin Immunol 1999; 103: 408-414
Functional Endoscopic Sinus Surgery
Functional endoscopic sinus surgery is the mainstay in the surgical treatment of sinusitis and nasal polyps, including bacterial, fungal, recurrent acute, and chronic sinus problems. Ample research supports its record of safety and success...
(FESS).
Balloon sinuplasty is an endoscopic, catheter
Catheter
In medicine, a catheter is a tube that can be inserted into a body cavity, duct, or vessel. Catheters thereby allow drainage, administration of fluids or gases, or access by surgical instruments. The process of inserting a catheter is catheterization...
-based system for patients suffering from sinusitis. The procedure has been cleared by the U.S. Food and Drug Administration. It uses a small, flexible balloon catheter to enlarge sinus passageways. When the balloon is inflated, it widens the walls of the sinus passageway, with the goal of restoring normal sinus drainage without damaging the sinus lining.
The Procedure
Sinus surgery with Balloon Sinuplasty may be performed safely in a hospital, outpatient surgery center, or a doctor's office. The surgeon and patient will determine whether the procedure is best done under traditonal general anesthesia or local anesthesia depending upon the patient's medical history and the type of sinus disease that needs to be managed.When performing Balloon Sinuplasty, the physician inserts a sinus guide catheter through the nostril to gain access to the sinus ostia (opening) under endoscopic visualization. The endoscope allows the physician to see through the nasal passages to the sinus cavities to ensure that he/she is inserting the catheter into the proper location. A sinus guide wire or sinus illumination system is then introduced into the targeted sinus via the sinus guide catheter. The sinus illumination system provides a targeted fiber optic light transmission that helps the physician place the sinus guide catheter in the correct place. When the Balloon Sinuplasty system was introduced in 2005, illuminated wires did not exist and surgeons confirmed the location of the wires with low level xray using flouroscopy.
Once access to the intended location is confirmed by light or flouroscopy, a balloon catheter is introduced into the sinus cavity over the sinus guide wire or sinus illumination system and positioned in the blocked ostium for inflation. Once the position has been confirmed visually, the balloon is inflated to unblock the narrow or blocked ostium. The balloon is then deflated and removed. Next, an irrigation catheter may be advanced over the sinus guide wire or sinus illumination system to flush out the sinus of any mucus or pus. Finally, the sinus irrigation catheter is removed from the sinus to allow the sinus cavity to drain any mucus and/or pus. Newer balloon cathers have the irrigation system incorporated into the balloon making the procedure simpler with fewer steps.
History
Balloon sinuplasty technology was developed by Acclarent, Inc.Acclarent, Inc.
Acclarent, Inc. is a privately-held, venture-backed company. It is based in Menlo Park, San Mateo County, California. Acclarent develops technology for the ENT medical field.- History :...
, and was brought to market in 2005, after FDA approval. Patients with sinus disease in the maxillary sinus (under the cheek), frontal sinus (over the eyes), and sphenoid sinus (in the middle of the head) and caused by obstruction can benefit from Balloon Sinuplasty. Balloon Sinuplasty technology is not used in the ethmoid sinuses (between the eyes). Balloon Sinuplasty can be used alone to manage disease in the frontal, maxillary or sphenoid sinuses. It can be combined with traditional sinus technologies to manage disease in the maxillary, frontal and/or sphenoid sinus when there is disease in the ethmoid sinus (hybrid procedure). Once the sinus is open, a culture of the mucus can be obtained with an irrigating catheter to test for specific bacteria and/or fungus. Balloon procedures alone may offer adequate visualization to insert tools to obtain biopsies, however,if it does not, a hybrid procedure can be perfomred to offer the surgeon the ability to send biopsy material for examination under the pathologist's microscope in order to rule out cancer or other important diseases that may be found in the sinuses. When performed as an isolated procedure, Balloon Sinuplasty has a high safety record. When combined as a hybrid procedure, there is a small risk of damage to the brain and eyes because of the performance of the traditional operation.
Just like traditional surgery, for those patients who have infection in the bone of the sinuses (osteitis), hybrid Balloon Sinuplasty surgery may be needed followed by long term antibiotics given by mouth or intravenously. Since Balloon Sinuplasty permits surgical management of the sinus disease with preservation of tissue and rarely requires packing, return to normal activities may occur earlier than traditional sinus surgical procedures. As with any sinus surgery, Balloon Sinuplasty or traditional surgery, additional treatment medically or surgically may be needed depending the cause of the sinus disease. .
Additional reading
1. Brown, CL, et al.; Safety and Feasibility of Balloon Catheter Dilation of Paranasal Sinus Ostia: A Preliminary Investigation; Annals of Otology, Rhinology & Laryngology April 2006, Vol. 115(4): 293-2992. Bolger, WE, et al.; Catheter Based Dilation of the Sinus Ostia: Initial Safety and Feasibility Analysis in a Cadaver Model; American Journal of Rhinology May-June 2006, Vol. 20, No. 3, P. 290-294
3. Benninger, M., Otolaryngology Head and Neck Surgery 2003; 129S: s1-S32
4. Gliklich, R., et al., Journal of Allergy Clin Immunol 1999; 113: 104-109
5. Ray, N., et al., Journal of Allergy Clin Immunol 1999; 103: 408-414