Accuracy of Transnasal Cannulation and Dilation of the Maxillary Ostium in Cadavers with Intact Uncinates

Brodner, David; Alexander, Ian J.; Chandler, Stephen F.; Cutler, Jeffrey L.; Saigal, Kapil

doi:10.2500/ajra.2012.26.3852

Cited by 7 publications

(12 citation statements)

References 16 publications

(18 reference statements)

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“…Die gemessene Strahlenexposition ist für den Patienten (Auge, Gesamtdosis) und den HNO-Arzt (Hand, Gesamtdosis, Brustbereich) sehr gering und liegt weit unter kritischen Schwellendosen oder der natürlichen Strahlenexposition, ist aber trotzdem zu beachten [1123][1124][1125][1126]. Neuentwicklungen betreffen eine biegbare Spitze, multifunktionale Dilatationsprodukte (Sonde, Spülung und Ballon) [1127], den zusätzlichen Einsatz von Spülsystemen [1128] und navigierbare Führungskatheter [1129] bzw. Führungsdrähte.…”

Section: Ballondilatationunclassified

Aktueller Stand der endonasalen Nasennebenhöhlenchirurgie

Weber

2015

Laryngo-Rhino-Otol

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Endonasal endoscopic sinus surgery is the standard procedure for surgery of most paranasal sinus diseases.Appropriate frame conditions provided, the respective procedures are safe and successful.These prerequisites encompass appropriate technical equipment, anatomical oriented surgical technique, proper patient selection, and individually adapted extent of surgery.The range of endonasal sinus operations has dramatically increased during the last 20 years and reaches from partial uncinectomy to pansinusoperation with extended surgery of the frontal (Draf type III), maxillary (grade 3-4, medial maxillectomy, prelacrimal approach) and sphenoid sinus.In addition there are operations outside and beyond the paranasal sinuses. The development of surgical technique is still constantly evolving.This article gives a comprehensive review on the most recent state of the art in endoscopic sinus surgery according to the literature with the following aspects: principles and fundamentals, surgical techniques, indications, outcome, postoperative care, nasal packing and stents, technical equipment.

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Section: Ballondilatationunclassified

Aktueller Stand der endonasalen Nasennebenhöhlenchirurgie

Weber

2015

Laryngo-Rhino-Otol

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“…In this study we sought to identify the true accuracy of the procedure in cannulating the natural ostia of the maxillary sinus. There is agreement in the literature that the maxillary sinus is the most difficult sinus to cannulate successfully using currently available balloon catheter dilation techniques . Challenges are due to the anatomic constraints and the sharp angle needed to navigate around the uncinate process.…”

Section: Discussionmentioning

confidence: 99%

“…All studies using direct visualization to confirm accuracy in the literature have been performed in cadaveric heads . Balloon sinuplasty in living patients has the potential for additional technical challenges absent in cadavers.…”

mentioning

confidence: 99%

“…To date, no study has assessed the accuracy of attempted intraoperative balloon dilations using direct visual confirmation. There is agreement in cadaveric studies performed to date that the maxillary sinus is the most difficult to successfully cannulate . This is likely due to the acute angle required to navigate around the uncinate process to access the natural ostia.…”

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confidence: 99%

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The intraoperative accuracy of maxillary balloon dilation: a blinded trial

Jensen¹,

Holbrook

Chen

et al. 2019

Int Forum Allergy Rhinol

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Background: Balloon sinus dilation (BSD) is a commonly performed sinus procedure in the United States. Several cadaveric studies have evaluated BSD accuracy and the maxillary sinus has consistently been shown to be the most challenging to cannulate. We designed an independent study to evaluate the intraoperative accuracy of maxillary sinus BSD. Methods:A prospective, single-blinded trial evaluating the accuracy of maxillary sinus BSD was performed using 2 commercially available BSD systems (guidewire-and probebased systems) randomly assigned to patients undergoing endoscopic surgery for chronic rhinosinusitus without nasal polyps (CRSsNP) or a skullbase approach in patients without sinus disease. All patients underwent maxillary BSD followed by uncinectomy to reveal dilation of the natural maxillary sinus ostia. The recorded procedures were reviewed by 3 fellowship-trained rhinologists from different institutions blinded to the BSD system utilized. The primary endpoint compared accuracy of maxillary BSD a empts. The secondary endpoint compared accuracy between the 2 systems.Results: Twenty-nine maxillary BSD procedures were performed in 18 patients (age range, 20-79 years; mean, 51 years) without nasal polyposis undergoing maxillary antrostomy as part of a more extensive procedure. BSD was successful in 18 of 29 (62%) a empts and unsuccessful in 9 of 29 (31%) a empts, with statistically "almost perfect" interrater agreement (kappa = 0.86). There was no statistical difference between the 2 BSD systems (p = 0.81). Conclusion:Maxillary BSD appeared to be less accurate in living patients when compared with findings from previously published cadaver studies. There were no differences in accuracy between the probe-and guidewire-based systems. This is the first non-industry-sponsored study evaluating maxillary sinus BSD in living patients. Further studies are needed to investigate the clinical implications of our findings. C 2019 ARS-AAOA, LLC.

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“…Nevertheless, the measured irradiation exposition is very low for the patients (eye, total dose) and the ENT surgeon (hand, total dose, breast) and it is significantly below the critical threshold dose or the natural radiation exposure, however, it must be observed nonetheless [ 1119 ], [ 1120 ], [ 1121 ], [ 1122 ]. New developments concern a flexible tip, multifunctional dilatation products (probe, rinsing, and ballooning) [ 1123 ], the additional application of rinsing systems [ 1124 ], and navigable guiding catheters [ 1125 ] or guide wires.…”

Section: Technical Equipmentmentioning

confidence: 99%