What Is Balloon Sinuplasty Procedure?
Balloon sinuplasty (BSP) is a procedure indicated mostly for the treatment of chronic rhinosinusitis (CRS), which is a prolonged untreated inflammation of the nasal passageways around the paranasal sinuses. The surgery may be considered a fundamental therapy with usage ranging from refractory to conservative ways, and this procedure has been popularized over the last decade to success. Since its preliminary introduction in the USA in 2004, it has become a popular technique worldwide owing to its potential to eliminate repeated bouts or frequent sinus infections and pathologies.
What Is the Rationale for Using Balloon Sinuplasty?
The concept of balloon sinuplasty uses the principle of balloon dilatation to open the anatomy of the paranasal sinuses, which is in fact a modification made by otolaryngologists and maxillofacial surgeons of the original concept that was employed in the 1970s when cardiac surgeons used this technique to operate upon the coronary arteries by dilating them. This also holds even more true in current scenarios when pharmacologic aids cannot provide the patient emergency relief from orofacial pain and discomfort to patients suffering from sinusitis, extended sinus pathologies, and rhinosinusitis.
This technique is popular because of the sophisticated technology that uses the balloon dilatational system for dilating the sinus ostia. Over the last decade, with further refinements in this technique, an added benefit for the surgeon or the operator has been achieved where it provides the ability to be able to perform the procedure outside of an operating room. Now more patients who suffer from chronic rhinosinusitis may opt or elect to undergo this procedure. The other benefit indicated by the current standards is the lower complication rates as well as diminished recovery time for the patient.
What Are the Equipment Used in Balloon Sinuplasty?
The main equipment used in this procedure is as follows :
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Straight or Angled Endoscopes - This is the main rigid nasal endoscope used by the maxillofacial surgeon for viewing the sinonasal anatomy in detail before performing the procedure.
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Guide Catheter - This acts as a direct guide so that the device tip can be oriented properly towards the intended ostia site.
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Guidewires - These are the parts that aid in the safe entry of the catheter into the correct sinus by the surgeon. When the guidewires are used with fluoroscopic imaging, they can be radiopaque, and they can also as well be a source of transillumination to the sinus path and act as external guidance to the operator.
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Balloon Catheters - This is the fundamental part of the equipment used for the dilatation of the ostia. The inflation range is usually considered by the operator to certain pressures (approximately within the range of 8 to 12 atmospheres).
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The Balloon Inflation Device - This device is rather a high-pressure system that is used for primary inflation of the balloon itself.
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Irrigation catheter - This catheter washes out the purulent materials and flushes the accessory debris out of the sinus effectively.
The patient can undergo this procedure under local anesthesia itself. By the deft use of the balloon inflation system, the balloons inflate the sinus openings or the ostia allowing the infection to drain easily, also this procedure, unlike ESS or FESS (endoscopic sinus surgery or functional endoscopic sinus surgery), does not require any invasive skin cutting and allows for effective drainage of the sinus infections.
What Are the Potential Complications of Balloon Sinuplasty?
Just like any other type of medical intervention or surgery, postoperative complications may be a routine development. Complications, if any, are relatively rare as compared to conventional endoscopic sinus surgeries. With this procedure, potential complications may occur with the balloon sinus dilation. Care should be taken by the operator to prevent any tissue damage to the mucus membranes around the infected area or injury to the orbital region.
Rarely, postoperative side effects of either post-operative bleeding or allergic reaction to anesthesia or other medications administered in the course of the procedure would be reported and should be immediately managed by the healthcare provider or surgeon. Additionally, physical and strenuous activities like exercise, jogging, swimming, etc. should not be performed, preferably, for up to two weeks post BSP. Smoking and alcohol consumption should be strictly prohibited by the patient, as instructed by the healthcare provider or surgeon, as it can aggravate edema or swelling post-operatively.
What Are the Contraindications of Balloon Sinuplasty?
Patients with certain predispositions are contraindicated for this procedure. Some of the contraindicated conditions are:
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Headache without acute or chronic rhinosinusitis.
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Sleep apnea or sleep-related apneas (existing either with or without acute or chronic forms of rhinosinusitis).
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This procedure cannot be performed in rhinosinusitis patients without crosschecking by CT (computed tomography) scans or in an otherwise asymptomatic patient who may be suffering from related clinical symptoms, unrelated to rhinosinusitis.
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Allergic cases of fungal sinusitis disease.
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Cystic fibrosis.
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Malignant tumors.
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Skull-based dehiscence lesions.
What Are the Post-procedure Management Strategies?
Few general recommendations to be followed by an individual after balloon sinuplasty includes the following:
- After the procedure, the physician performs a mental status exam and a vision assessment.
- The physician might prescribe corticosteroids for a short course and a saline nasal spray.
- It is mandatory to be regular to the follow-up appointments with nasal endoscopy exactly after one week, three months, and one year after the surgery.
- After three months of surgery, a CT scan is recommended for comparing Lund-McKay scores.
- Comparisons will be made between the preoperative quality of life scores and the postoperative scores at 3, 6, and 12 months. The assessments will consist of various scales, such as the Sino-Nasal Outcome Test (SNOT-20), the Wong-Baker FACES Pain Scale, and the Rhinosinusitis Symptom Inventory, among other measures.
Conclusion:
Balloon sinuplasty is a very safe technique considered by most physicians and maxillofacial surgeons in treating rhinosinusitis, not only because it is a minimally invasive process but also due to its added benefits. Complications that occur with this procedure are rare. Still, even if they appear in certain systemic conditions, they can be managed by immediate intervention by the procedural operator or surgeon or the physician and medical team. Patient consent before performing the procedure by the otolaryngologist or the maxillofacial surgeon, along with an analysis of contraindications by the operator, is crucial to achieving a successful procedure.
