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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

CT images demonstrated mucosal thickening of the left frontal sinus on coronal (A) and sagittal views (B), with residual bony remnants (arrow) obstructing the frontal sinus outflow tract.
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Figure 7: CT images demonstrated mucosal thickening of the left frontal sinus on coronal (A) and sagittal views (B), with residual bony remnants (arrow) obstructing the frontal sinus outflow tract.

Mentions: Nasal endoscopy showed evidence of a previous ethmoidectomy with a clear posterior skull base, but residual partitions could be appreciated within the frontal recess. A sinus CT was obtained, which demonstrated mucosal thickening of the left frontal sinus (Fig. 7A). Remnants of bone obstructing the frontal sinus outflow tract could also be appreciated on sagittal views (Fig. 7B). Left revision ESS was recommended, but the patient declined to undergo general anesthesia and instead elected to proceed with left revision frontal sinusotomy in the clinic. After topical and local anesthesia were administered, frontal sinus instruments and balloon dilation were used to remove the remaining bony ledges within the frontal recess and enlarge the natural ostium of the frontal sinus (Fig. 8, A–C). Significant polypoid inflammation was encountered within the frontal sinus (Fig. 8C). Therefore, a steroid-eluting implant (PROPEL mini, Intersect ENT) was placed (Fig. 9).


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)

CT images demonstrated mucosal thickening of the left frontal sinus on coronal (A) and sagittal views (B), with residual bony remnants (arrow) obstructing the frontal sinus outflow tract.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 7: CT images demonstrated mucosal thickening of the left frontal sinus on coronal (A) and sagittal views (B), with residual bony remnants (arrow) obstructing the frontal sinus outflow tract.
Mentions: Nasal endoscopy showed evidence of a previous ethmoidectomy with a clear posterior skull base, but residual partitions could be appreciated within the frontal recess. A sinus CT was obtained, which demonstrated mucosal thickening of the left frontal sinus (Fig. 7A). Remnants of bone obstructing the frontal sinus outflow tract could also be appreciated on sagittal views (Fig. 7B). Left revision ESS was recommended, but the patient declined to undergo general anesthesia and instead elected to proceed with left revision frontal sinusotomy in the clinic. After topical and local anesthesia were administered, frontal sinus instruments and balloon dilation were used to remove the remaining bony ledges within the frontal recess and enlarge the natural ostium of the frontal sinus (Fig. 8, A–C). Significant polypoid inflammation was encountered within the frontal sinus (Fig. 8C). Therefore, a steroid-eluting implant (PROPEL mini, Intersect ENT) was placed (Fig. 9).

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