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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

Follow-up nasal endoscopy showed the silastic stent in proper position but with mucopurulent secretions present (A). After stent removal and ostial dilation, inflamed mucosa could be seen lining the frontal sinus (B).
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Figure 4: Follow-up nasal endoscopy showed the silastic stent in proper position but with mucopurulent secretions present (A). After stent removal and ostial dilation, inflamed mucosa could be seen lining the frontal sinus (B).

Mentions: The patient did well for eight months, while continuing saline and budesonide rinses, but then returned once again presenting with left-sided forehead/periorbital pressure and discolored rhinorrhea. Inspection with a 70° endoscope revealed the stent to still be in the proper position with a stenosed but patent frontal ostium. However, the stent was clearly infected with yellow, mucopurulent secretions surrounding the foreign body (Fig. 4A). The stent was removed, revealing inflamed mucosa lining the frontal sinus (Fig. 4B). At this point, the patient was offered a Draf III procedure, but he declined to pursue any further surgical intervention. The pus was suctioned and sent for culture, which grew Pseudomonas putida, Stenotrophomonas maltophilia, and S. aureus. The frontal sinus ostium was enlarged using balloon dilation. A steroid-eluting sinus implant (PROPEL mini, Intersect ENT) was then deployed into the frontal sinus (Fig. 5A). The implant was positioned such that its inferior edge abutted the frontal ostium circumferentially (Fig. 5B), and the remainder interfaced with the inflamed frontal sinus mucosa to optimize drug delivery (Fig. 5C).


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)

Follow-up nasal endoscopy showed the silastic stent in proper position but with mucopurulent secretions present (A). After stent removal and ostial dilation, inflamed mucosa could be seen lining the frontal sinus (B).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Follow-up nasal endoscopy showed the silastic stent in proper position but with mucopurulent secretions present (A). After stent removal and ostial dilation, inflamed mucosa could be seen lining the frontal sinus (B).
Mentions: The patient did well for eight months, while continuing saline and budesonide rinses, but then returned once again presenting with left-sided forehead/periorbital pressure and discolored rhinorrhea. Inspection with a 70° endoscope revealed the stent to still be in the proper position with a stenosed but patent frontal ostium. However, the stent was clearly infected with yellow, mucopurulent secretions surrounding the foreign body (Fig. 4A). The stent was removed, revealing inflamed mucosa lining the frontal sinus (Fig. 4B). At this point, the patient was offered a Draf III procedure, but he declined to pursue any further surgical intervention. The pus was suctioned and sent for culture, which grew Pseudomonas putida, Stenotrophomonas maltophilia, and S. aureus. The frontal sinus ostium was enlarged using balloon dilation. A steroid-eluting sinus implant (PROPEL mini, Intersect ENT) was then deployed into the frontal sinus (Fig. 5A). The implant was positioned such that its inferior edge abutted the frontal ostium circumferentially (Fig. 5B), and the remainder interfaced with the inflamed frontal sinus mucosa to optimize drug delivery (Fig. 5C).

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