Instruments Equipment and Preparation

Fig. 25.1. Balloon Sinuplasty™ equipment. A Sinus guiding catheters. From top to bottom: 0°, 30°, 70°, 90°, and 110°. B Sinus balloon catheter, passed over a guide wire into the sinus guiding catheter. C Inflation device, consisting of a high-pres-

sure piston syringe and a manometer. The device is shown attached to a balloon catheter. D Sinus lavage catheter. (Images courtesy of Acclarent. Reprinted from [6] with permission from Elsevier)

Fig. 25.1. Balloon Sinuplasty™ equipment. A Sinus guiding catheters. From top to bottom: 0°, 30°, 70°, 90°, and 110°. B Sinus balloon catheter, passed over a guide wire into the sinus guiding catheter. C Inflation device, consisting of a high-pres-

sure piston syringe and a manometer. The device is shown attached to a balloon catheter. D Sinus lavage catheter. (Images courtesy of Acclarent. Reprinted from [6] with permission from Elsevier)

tiple attempts are required to dilate the sinus ostium, as well as if multiple sinus ostia are going to be dilated in the same session. The manufacturer provides a detailed explanation on how to reprep the balloon for adequate functioning. In addition, sinus lavage catheters are also available (Fig. 25.1d), which permits the irrigation and suction of the target sinus.

Although otolaryngologists rarely use the C-arm, it is readily available in the operating room and is relatively easy to use. The C-arm is positioned at the head of the table, in order to provide fluoroscopic guidance when cannulating the involved sinuses and performing balloon catheter insertion and inflation at the sinus ostia. Depending on the involved sinus(es), anteroposterior (AP) views or lateral views are used during catheter insertion and balloon positioning/inflation (Table 25.1). Unlike FESS, which is usually performed on all involved sinuses on one side, followed by the involved sinuses on the contralateral side, FEDS is best performed on each set of involved sinuses bilaterally (when indicated), in order to minimize the need to reposition the C-arm.

Tips and Pearls

■ In patients with involvement of all three groups of sinuses (sphenoid, maxillary, and frontal sinuses), it is suggested to start with the AP view for both maxillary sinuses, and to then proceed with both frontal sinuses under AP fluoroscopic control

If the cannulation of either frontal sinus is not achieved with AP views, the contralateral sinus is treated first; then the C-arm is switched to the lateral position to obtain a lateral view, in order to aid in directing the guide wire into the sinus, across the frontal recess. The sphenoid sinuses are cannulated last, with the guidance of a lateral fluoroscopic view. This again minimizes the time required for repositioning the C-arm and obtaining the appropriate image with the help of the technician. A proper positioning of the

C-arm enables the surgeon to have the most adequate view, in order to facilitate sinus cannulation, and to keep the patient's radiation exposure to a minimum. During the procedure, live fluoroscopy is usually only used to guide wire cannulation of the involved sinus, positioning of the balloon after it is advanced over the wire, and during inflation/deflation. An effort should be made to use still images whenever possible in order not to exceed a total radiation exposure time of 15-20 min.

The procedure, like FESS, can be performed under general anesthesia, or with local anesthesia with or without sedation. Since the procedure is very short, local anesthesia is more commonly used than it is with FESS.

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