Part II: Balloon Sinuplasty Surgery
Understanding Balloon Sinuplasty Surgery
The balloon sinuplasty surgery came into existence as a result of the search for a more modern approach to functional endoscopic sinus surgery. Many experts, researchers and surgeons alike in the medical community find this option as groundbreaking as a minimally invasive procedure. The technique may shorten recovery time in a very select group of patients, and provide those suffering from chronic sinusitis with the same results as more invasive options.
Balloon sinuplasty is similar to FESS in that both procedures involve the use of an endoscopic surgical instrument that is used to eliminate blockages in the four paranasal sinuses. The types of symptoms that normally qualify a patient to receive a balloon sinuplasty are identical to those required for a FESS procedure. These symptoms include a diagnosis of acute, recurrent acute, or chronic sinusitis, in addition to a poor response to traditional antibiotics and other medications used to treat the condition.
The U.S. Food and Drug Administration approved the procedure as a method of treatment for chronic sinusitis. Generally, it is described as an endoscopic, catheter-based procedure, involving the placement of a balloon on a wire catheter used to remove blockages in the sinus passageways. When the balloon is inflated, it may widen the walls of the sinus passageway, with the goal of restoring normal drainage without permanently damaging the sinus lining. Tissue is not removed by the balloon but a Functional Endoscopic Sinus Surgery, FESS, may be performed at the same time, to remove extra or infected tissue.
The procedure, also commonly referred to as a Balloon Sinus Dilation (or “BSD”) allows for flexibility because it can be performed in either a hospital or surgery center. Alternatively, the surgery may also be performed as an outpatient procedure at a doctor’s office.
The patient has the option of selecting general, local anesthesia, or no anesthesia, depending upon the patient’s general physical condition and an independent evaluation conducted by an anesthesiologist.
When beginning the procedure, your surgeon will insert a catheter into your nostril and through the sinus opening via the aid of endoscopic fiber optics. Next, a sinus guide-wire is placed into the infected sinus. A second catheter is then placed into the same infected sinus cavity, with a balloon attached to the end. Subsequently, the infected area is released of any blockages through inflation of the balloon. The surgeon will cautiously ensure that the balloon is inflated to the appropriate size and pressure to make sure that your sinuses are opened to allow for normal, healthy draining of mucus.
Afterwards, your surgeon will deflate the balloon and carefully remove it. Lastly, the third and final catheter (called an irrigation catheter) is used to flush out any remaining debris or bacteria that remained in the targeted sinus.
The procedure takes between one to one-and-a-half hours, and you will likely feel healthy enough to return to work and your daily routine in approximately two days. After one to two months, the majority of patients experience a full recovery and the ability to breath normally, without the previous inflammations or nasal drainage blockage problems.
Possible Risks and Complications
It is imperative that surgeons create a setting in which to allow for fast and efficient response to possible complications of the BSD procedure.
Like all sinus surgery options, BSD is not alone in the existence of various risks of which you, as a patient, must be aware. Common complications include:
- Extensive bleeding following surgery, requiring nasal packing and general discomfort
- Problems during surgery involving the visualization and instrumentation
- Persistent of early return of infection
- Later need for revision
Since balloon sinuplasty surgery is concerned chiefly with the dilation of obstructions and blockages of the ostia, only patients with complications relating to three of the four paranasal sinuses (frontal, sphenoid, and maxillary) are candidates for the procedure.
An additional limitation exists in patients who suffer from an extraordinarily severe form of chronic sinusitis. This group of patients require a more invasive procedure in order to properly treat their condition. Thus, BSD is available only to those characterized as having “mild to moderate” cases of chronic sinusitis.
BSD is not usually appropriate as an isolated procedure for patients where there are nasal polyps or tissue needs to be removed. A FESS procedure or combined procedure may be a better choice.
Lastly, BSD is not yet an option for patients who have symptoms related what is referred to as a “bony thickening or dehiscence of the orbital wall or skull base.”
BSD Final Thoughts
Balloon sinus dilation, or balloon sinuplasty surgery is another step toward a focus on the promotion of tissue preservation. The purpose is to decrease the often-damaging and destructive techniques that affect the delicate tissues of the sinuses and nasal cavity. Comparisons have been made between this new form of sinus surgery and angioplasty, in that just as an angioplasty avoids the more invasive and overall more-destructive bypass graft surgery through opening up the coronary artery, BSD avoids the FESS procedure by opening up the sinus passages without destruction of nasal tissues. A failed BSD procedure will likely require an additional FESS procedure.
BSD is a procedure that is not without its own separate set of risks and complications. In choosing whether BSD is an option, patients must be cognizant of their symptoms and which paranasal sinuses are affected, in order to make the most well informed decision.