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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

Postoperative nasal endoscopy revealed mucopurulent discharge with no frontal ostium visualized (A). After reopening of the frontal sinus outflow tract, a silastic stent was placed to maintain ostial patency (B).
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Figure 3: Postoperative nasal endoscopy revealed mucopurulent discharge with no frontal ostium visualized (A). After reopening of the frontal sinus outflow tract, a silastic stent was placed to maintain ostial patency (B).

Mentions: However, the patient missed all of his subsequent follow-up visits for postoperative debridement. He then returned to our clinic two months later, complaining of recurrent left-sided frontal pressure and discolored rhinorrhea. On nasal endoscopy, mucopurulent drainage was present, and the frontal sinus outflow tract could no longer be visualized (Fig. 3A). Cultures were obtained and grew Streptococcus pneumoniae and Pantoea species. Under local anesthesia, frontal sinus instruments as well as balloon dilation were used to reopen the ostium in the clinic. This was repeated on multiple appointments over the span of six to eight weeks and the patient placed on culture-directed antibiotics. Nevertheless, the ostium continued to close in between visits, leading to persistent infection. Ultimately, due to issues with patient compliance, a silastic stent was placed to maintain frontal sinus ostial patency (Fig. 3B).


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)

Postoperative nasal endoscopy revealed mucopurulent discharge with no frontal ostium visualized (A). After reopening of the frontal sinus outflow tract, a silastic stent was placed to maintain ostial patency (B).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Postoperative nasal endoscopy revealed mucopurulent discharge with no frontal ostium visualized (A). After reopening of the frontal sinus outflow tract, a silastic stent was placed to maintain ostial patency (B).
Mentions: However, the patient missed all of his subsequent follow-up visits for postoperative debridement. He then returned to our clinic two months later, complaining of recurrent left-sided frontal pressure and discolored rhinorrhea. On nasal endoscopy, mucopurulent drainage was present, and the frontal sinus outflow tract could no longer be visualized (Fig. 3A). Cultures were obtained and grew Streptococcus pneumoniae and Pantoea species. Under local anesthesia, frontal sinus instruments as well as balloon dilation were used to reopen the ostium in the clinic. This was repeated on multiple appointments over the span of six to eight weeks and the patient placed on culture-directed antibiotics. Nevertheless, the ostium continued to close in between visits, leading to persistent infection. Ultimately, due to issues with patient compliance, a silastic stent was placed to maintain frontal sinus ostial patency (Fig. 3B).

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