Abstract
Background
In chronic maxillary sinusitis, pathologic mucosas of the anterior and lateral walls of the maxillary sinus are difficult to remove. Trocar insertion to the canine fossa is the most commonly used procedure. In the present work, we report a method involving a balloon dilatation technique for treatment of intramaxillary lesions using a Foley catheter in chronic maxillary sinusitis and the outcomes of this approach.
Methods
Records of 34 patients with intramaxillary sinus lesions who underwent endoscopic sinus surgery were analyzed. After widening the natural ostium, a 10F Foley catheter was inserted through the widening ostium into the maxillary sinus. The intramaxillary lesion was removed by repeated balloon inflation and deflation of the Foley catheter. The patients were followed-up for at least 6 months after the surgery.
Results
There were no significant intraoperative or postoperative complications. We found that the postoperative symptoms and resolution of the lesions in comparison to classic functional endoscopic sinus surgery were not different in authors’ experiences.
Conclusion
The balloon dilatation technique using a Foley catheter is a minimally invasive and effective technique that is not associated with major complications in cases of intramaxillary lesions.
1
Introduction
Endoscopic sinus surgery (ESS) has become the standard treatment for patients with sinusitis that does not respond to medical management, but ESS has variable success rates of 75% to 95% . One of the hallmarks of ESS has been the continued introduction of innovative instruments underscored by the common goals of minimal invasiveness and maximum preservation of normal tissue and mucosa . ESS has proven to be a minimally invasive surgical choice. In chronic maxillary sinusitis, ESS is used to widen the natural ostium and remove pathologic lesions. However, pathologic mucosas of the anterior and lateral walls of the maxillary sinus are difficult to remove. Consequently, trocar insertion to the canine fossa is commonly performed. In the present work, we describe a new balloon dilatation technique for removing the chronic inflammatory lesion in chronic maxillary sinusitis.
2
Materials and methods
A retrospective analysis of the records of 34 patients with chronic maxillary sinusitis who underwent the balloon dilatation technique using a Foley catheter balloon was performed between February 2007 and March 2008 at Chuncheon Sacred Heart Hospital (Kangwon, Korea). All patients had a diagnosis of chronic maxillary sinusitis that had not responded to medical management and had not undergone ESS. The exclusion criteria consisted of previous sinus surgery, lesions located in the frontal sinus, sphenoid sinus or posterior ethmoid cells, and the fungal sinusitis. All patients had maxillary sinus or maxillary sinus with haziness of anterior ethmoid cells on 3-mm paranasal computed tomographic (CT) scan findings. We performed the evaluation of preoperative and postoperative CT score based on the maxillary sinus as follows: CT score 0, no evidence of sinusitis; CT score 1, mucosal filling intensity; CT score 2, half soft tissue filling intensity; and CT score 3, total soft tissue filling intensity ( Fig. 1 A–C). And we compared patients’ subjective symptoms between preoperative and postoperative symptoms at least 6 months after the surgery.
2.1
Operative techniques
The surgery was performed under general anesthesia. A rigid telescope with a 4-mm diameter at 0° or 30° was used. The surgical procedure of the endoscopic approach was done while observing a video monitor of the nasal surgical findings. After topical and infiltration anesthesia, the uncinate process was resected. The natural ostium was widened using backbiting forceps or microdebrider about a diameter of 1.5 to 2 cm, and a 10F Foley catheter was inserted through the widening ostium into the maxillary sinus using the upward forceps ( Fig. 2 A and B). The balloon was positioned on edematous mucosas of the anterolateral wall in the maxillary sinus, and about 10 to 20 cm 3 of the normal saline was injected into the Foley catheter under endoscopic guidance for balloon inflation ( Fig. 2 C and D). The pathologic edematous or polypoid mucosa was ruptured by the balloon inflation, and its contents and discharge pushed through the natural ostium ( Fig. 2 D and E). After balloon deflation, we examined the remnant edematous or polypoid mucosa under endoscopic guidance. The inflation was performed repeatedly after repositioning the balloon at the remnant lesion. We could find the improved pathologic mucosal lesion and remove the remnant of squeezed pathologic mucosa by using the endoscopic forceps or microdebrider ( Fig. 2 F).
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