Definition & Overview

Sinuplasty is a surgical procedure for opening and reshaping the sinus passages to treat inflammation and other sinus conditions.

The sinuses are hollow cavities located within the skull and are identified based on their locations. These include the maxillary, sphenoid, frontal, and ethmoid sinuses. In most cases, the sinuses are empty and are believed to help humidify the air that goes inside the body. There is a thin layer of mucus found in each sinus, which normally drains into the nose through small passages. During infections and even allergic reactions, these sinus passages can be blocked, leading to stuffy nose and discomfort.

There had been several techniques employed to treat different sinus conditions. One of them is balloon sinuplasty, which treats these conditions while avoiding extensive damage to the sinuses. Sinuplasty is also sometimes performed as part of functional endoscopic sinus surgery (FESS), which is meant to restore a clear pathway of mucus from the sinuses by removing any blockage in the passages.

Who Should Undergo and Expected Results

Sinuplasty can be recommended to patients diagnosed with:

  • Chronic sinusitis - This condition is characterised by the repeated inflammation of the sinuses that no longer responds to over-the-counter medications.
  • Acute sinusitis - Those with severe cases of acute sinusitis may also find benefit from sinuplasty. This condition is typically caused by viral, bacterial, or fungal infections that lead to nasal congestion due to the overproduction of mucus.
  • Allergic rhinitis - In some cases, sinuplasty may be offered to patients suffering from recurring allergic rhinitis, particularly those who have been complaining of nasal stuffiness, itching, and constant sneezing for an extended period. These patients typically consider the procedure after they have tried several treatment options but are unable to find relief for their conditions.
  • Turbinate hypertrophy - There are also few cases of turbinate hypertrophy that are indicated for sinuplasty. This condition results from the enlargement of the ridges found in the nasal septum or the wall dividing the nostrils. In this case, sinuplasty is performed as part of the overall treatment program.
    It is good to note that sinuplasty is often not indicated for people suffering from nasal polyps, suspected neoplasm, and extreme cases of fungal diseases of the sinuses. This procedure is also not indicated for those suffering from chronic inflammation of the ethmoid sinus as these sinuses are located in between the eyes, near the bridge of the nose, and are hard to reach using a wire catheter.

As for the expected results, patients who underwent sinuplasty report favorable results following the procedure. Most cases of nasal pathway blockage have been treated successfully, with fewer complications and faster recovery time. Patients no longer had to rely on pharmaceutical drugs for relief of symptoms and can resume normal, daily activities after a few days of rest.

How is the Procedure Performed?

This procedure is performed in a hospital operating room under general anaesthesia, which means that patients are asleep throughout the procedure and will not feel any pain. Often, decongestants are also administered to help in the insertion of devices used for the procedure.

To begin sinuplasty, a guide catheter is inserted into the nasal passage and slowly advanced into the middle turbinate. The doctor achieves visuals of the affected part using fluoroscopy or x-ray. This helps in monitoring the progress of the guide wire and also helps keep it away from the walls of the sinuses to avoid injury or damaging surrounding tissues.

The balloon is then inserted through the catheter until it reaches the sinus ostium, the opening that connects a sinus to the nasal cavity. After making sure that the catheter is in the correct position, the surgeon inflates the balloon until it reaches the desired diameter, expanding the sinus passages in the process. The balloon is then deflated immediately and removed together with the catheter.

The same procedure is followed during sinuplasty of the maxillary sinuses, which are found in the cheekbones. However, a puncture is initially made in the anterior maxillary wall to allow catheter access to the internal maxillary ostium.

Possible Risks and Complications

Sinuplasty is considered a safe and straightforward process. However, just like any invasive surgical procedure, it comes with risks, which include:

  • Adverse reaction to the anaesthesia used
  • Infection – Infection following the procedure is also another possible risk, especially in a poorly performed procedure. This could lead to further distress and discomfort to the patient.
  • Postoperative edema – This can occur if the balloon was not immediately deflated.
  • Damage to sinuses walls - In some rare instances, damage to the walls of the sinuses is reported. This could be caused by injury or trauma to the surrounding tissues. Damage to the optic nerve is also another possible complication.
  • Excessive bleeding - This can occur if nearby tissues are injured. Leaking of fluid to the surrounding parts like the brain is also possible.

    References:

  • Brown CL, Bolger WE. Safety and feasibility of balloon catheter dilation of paranasal sinus ostia: a preliminary investigation. Ann Otol Rhinol Laryngol. 2006 Apr. 115(4):293-9; discussion 300-1.

  • Bolger WE, Brown CL, Church CA, Goldberg AN, Karanfilov B, Kuhn FA. Safety and outcomes of balloon catheter sinusotomy: a multicenter 24-week analysis in 115 patients. Otolaryngol Head Neck Surg. 2007 Jul. 137(1):10-20.

  • Raghunandhan S, Bansal T, Natarajan K, Kameswaran M. Efficacy & outcomes of balloon sinuplasty in chronic rhinosinusitis: a prospective study. Indian J Otolaryngol Head Neck Surg. 2013 Aug. 65:314-9.

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