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In-office use of a steroid-eluting implant for maintenance of frontal ostial patency after revision sinus surgery.

Janisiewicz A, Lee JT - Allergy Rhinol (Providence) (2015)

Bottom Line: The clinical presentation, in-office intervention, and treatment outcomes were examined.Two patients (male, 63 and 68 years of age) with a history of multiple ESS presented with recurrent unilateral frontal headache refractory to medical therapy.Nasal endoscopy/imaging revealed frontal sinus outflow obstruction.

View Article: PubMed Central - PubMed

Affiliation: Orange County Sinus Institute, Southern California Permanente Medical Group, Irvine, California, USA.

ABSTRACT
Achieving long-term, successful outcomes with endoscopic sinus surgery (ESS) can be challenging in patients with recalcitrant chronic rhinosinusitis (CRS). Local complications, including scar formation and ostial stenosis, can lead to recurrent blockage and subsequent relapse. The frontal sinus is particularly vulnerable to surgical failure given its narrow outflow and inaccessibility to topical therapies. The advent of steroid-eluting sinus implants has enhanced ESS outcomes, with significant reductions in synechiae, inflammation, and secondary postoperative interventions when placed in the ethmoid cavity. However, use of this technology in the frontal sinus has yet to be described. The purpose of this report is to present two cases, in which in-office frontal placement of a mometasone furoate (MF)-eluting implant facilitated maintenance of ostial patency after revision ESS. The clinical presentation, in-office intervention, and treatment outcomes were examined. Two patients (male, 63 and 68 years of age) with a history of multiple ESS presented with recurrent unilateral frontal headache refractory to medical therapy. Nasal endoscopy/imaging revealed frontal sinus outflow obstruction. Both declined revision ESS under general anesthesia and underwent endoscopic frontal sinustomy/ostial dilation in the clinic. A MF-eluting implant was placed in the frontal sinus at the end of the procedure, with preservation of ostial patency upon last follow-up at 3 and 11 months, respectively. In-office placement of a MF-eluting implant successfully maintained frontal ostial patency in patients with a history of multiple ESS. Additional randomized trials are necessary to determine statistical significance, cost-effectiveness analysis, and long-term efficacy of frontal sinus implantation.

No MeSH data available.


Related in: MedlinePlus

Preoperative coronal (A and B) and axial (C) CT images demonstrated complete opacification of the left frontal sinus (start) with an absent lateral wall, corresponding to the superomedial aspect of the orbit (arrows).
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Figure 1: Preoperative coronal (A and B) and axial (C) CT images demonstrated complete opacification of the left frontal sinus (start) with an absent lateral wall, corresponding to the superomedial aspect of the orbit (arrows).

Mentions: On nasal endoscopy, the patient was found to have a stenosed antrostomy with a residual uncinate process. There was also evidence of a partial ethmoidectomy with remaining partitions along the anterior skull base. The middle turbinate appeared to have been previously resected. No frontal sinus outflow tract could be visualized, and thick synechiae could be seen obstructing the frontal recess. After a three-week course of broad spectrum antibiotics, a computed tomography (CT) scan was obtained. Complete opacification of the left frontal sinus was shown with an absent lateral wall, corresponding to the superomedial aspect of the orbit (Fig. 1, A–C). Due to his persistent symptoms and radiographic findings, the patient elected to proceed with left revision endoscopic sinus surgery. Triplanar stereotactic imaging was performed in preparation for computer-assisted surgical navigation.


In-office use of a steroid-eluting implant for maintenance of frontal ostial patency after revision sinus surgery.

Janisiewicz A, Lee JT - Allergy Rhinol (Providence) (2015)

Preoperative coronal (A and B) and axial (C) CT images demonstrated complete opacification of the left frontal sinus (start) with an absent lateral wall, corresponding to the superomedial aspect of the orbit (arrows).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4388880&req=5

Figure 1: Preoperative coronal (A and B) and axial (C) CT images demonstrated complete opacification of the left frontal sinus (start) with an absent lateral wall, corresponding to the superomedial aspect of the orbit (arrows).
Mentions: On nasal endoscopy, the patient was found to have a stenosed antrostomy with a residual uncinate process. There was also evidence of a partial ethmoidectomy with remaining partitions along the anterior skull base. The middle turbinate appeared to have been previously resected. No frontal sinus outflow tract could be visualized, and thick synechiae could be seen obstructing the frontal recess. After a three-week course of broad spectrum antibiotics, a computed tomography (CT) scan was obtained. Complete opacification of the left frontal sinus was shown with an absent lateral wall, corresponding to the superomedial aspect of the orbit (Fig. 1, A–C). Due to his persistent symptoms and radiographic findings, the patient elected to proceed with left revision endoscopic sinus surgery. Triplanar stereotactic imaging was performed in preparation for computer-assisted surgical navigation.

Bottom Line: The clinical presentation, in-office intervention, and treatment outcomes were examined.Two patients (male, 63 and 68 years of age) with a history of multiple ESS presented with recurrent unilateral frontal headache refractory to medical therapy.Nasal endoscopy/imaging revealed frontal sinus outflow obstruction.

View Article: PubMed Central - PubMed

Affiliation: Orange County Sinus Institute, Southern California Permanente Medical Group, Irvine, California, USA.

ABSTRACT
Achieving long-term, successful outcomes with endoscopic sinus surgery (ESS) can be challenging in patients with recalcitrant chronic rhinosinusitis (CRS). Local complications, including scar formation and ostial stenosis, can lead to recurrent blockage and subsequent relapse. The frontal sinus is particularly vulnerable to surgical failure given its narrow outflow and inaccessibility to topical therapies. The advent of steroid-eluting sinus implants has enhanced ESS outcomes, with significant reductions in synechiae, inflammation, and secondary postoperative interventions when placed in the ethmoid cavity. However, use of this technology in the frontal sinus has yet to be described. The purpose of this report is to present two cases, in which in-office frontal placement of a mometasone furoate (MF)-eluting implant facilitated maintenance of ostial patency after revision ESS. The clinical presentation, in-office intervention, and treatment outcomes were examined. Two patients (male, 63 and 68 years of age) with a history of multiple ESS presented with recurrent unilateral frontal headache refractory to medical therapy. Nasal endoscopy/imaging revealed frontal sinus outflow obstruction. Both declined revision ESS under general anesthesia and underwent endoscopic frontal sinustomy/ostial dilation in the clinic. A MF-eluting implant was placed in the frontal sinus at the end of the procedure, with preservation of ostial patency upon last follow-up at 3 and 11 months, respectively. In-office placement of a MF-eluting implant successfully maintained frontal ostial patency in patients with a history of multiple ESS. Additional randomized trials are necessary to determine statistical significance, cost-effectiveness analysis, and long-term efficacy of frontal sinus implantation.

No MeSH data available.


Related in: MedlinePlus