Endoscopic Sinus Surgery
Balloon Dilation of the Frontal Recess in Revision Endoscopic Sinus Surgery

Balloon dilation of the frontal recess is an adjunctive technique used in revision endoscopic sinus surgery. Balloon sinuplasty, once regarded as a treatment for mild to moderate chronic sinusitis, is now recognized as an “instrument” which facilitates endoscopic sinus surgery on patients with even severe chronic sinusitis, polyps, mucoceles, allergic mucin impactions, prior surgery and scar tissue. The following case illustrates the ability of the balloon catheter to safely and effectively dilate the frontal recess in a patient with several years of severe chronic sinusitis symptoms and complete opacification of the frontal sinus despite multiple and prolonged courses of antibiotics, steroids and topical therapies. The patient has a history of prior endoscopic sinus surgery greater than 10 years ago. In the surgical video, the left frontal recess is addressed. An initial attempt at balloon dilation was unsuccessful. Therefore a traditional partial ethmoidectomy with through-cutting forceps is performed to address remnant ethmoid partitions. The frontal recess is then successfully dilated. Purulent secretions and a large green sinolith are expelled from the left frontal sinus. The frontal sinus is then irrigated with sterile saline via a catheter inserted, over the lighted guide wire, into the sinus. Bony partitions which were intentionally fractured with the balloon are then removed from the recess with giraffe forceps. Frontal recess mucosa is preserved. Dissolvable carboxymethylcellulose foam is placed in the recess at the conclusion of the procedure. Six months post-operatively the frontal recess is widely patent.

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