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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

Endoscopic photograph at three weeks (A) postimplant showed an open frontal ostium with residual fragments still present. By 10 weeks (B), the implant had resorbed completely, with frontal ostial patency maintained upon last follow-up at 11 months (C).
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Figure 6: Endoscopic photograph at three weeks (A) postimplant showed an open frontal ostium with residual fragments still present. By 10 weeks (B), the implant had resorbed completely, with frontal ostial patency maintained upon last follow-up at 11 months (C).

Mentions: Three and six weeks after implantation, the frontal ostium remained open with residual fragments still visible (Fig. 6, A and B). By 10 weeks, the implant had resorbed completely (Fig. 6C), with frontal ostial patency maintained upon last follow-up at 11 months (Fig. 6D). During the follow-up period, clear mucus would be suctioned at times around the ostium, but no crusting ever developed and no debridements were necessary to keep the stent patent before its absorption. The implant resorbed completely by 10 weeks without the need for removal of fragments. The patient has had no evidence of recurrent infection and has not required any further topical or systemic steroids since sinus implantation.


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)

Endoscopic photograph at three weeks (A) postimplant showed an open frontal ostium with residual fragments still present. By 10 weeks (B), the implant had resorbed completely, with frontal ostial patency maintained upon last follow-up at 11 months (C).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 6: Endoscopic photograph at three weeks (A) postimplant showed an open frontal ostium with residual fragments still present. By 10 weeks (B), the implant had resorbed completely, with frontal ostial patency maintained upon last follow-up at 11 months (C).
Mentions: Three and six weeks after implantation, the frontal ostium remained open with residual fragments still visible (Fig. 6, A and B). By 10 weeks, the implant had resorbed completely (Fig. 6C), with frontal ostial patency maintained upon last follow-up at 11 months (Fig. 6D). During the follow-up period, clear mucus would be suctioned at times around the ostium, but no crusting ever developed and no debridements were necessary to keep the stent patent before its absorption. The implant resorbed completely by 10 weeks without the need for removal of fragments. The patient has had no evidence of recurrent infection and has not required any further topical or systemic steroids since sinus implantation.

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