Transantral balloon dilation plus posterior ethmoidectomy.

OBJECTIVES/HYPOTHESIS: Transantral endoscopic balloon dilatation (TABD) was recently introduced for the management of limited mild maxillary and ethmoid disease. An expanded approach by inserting surgical tools into the antrum via a second port, directed toward the maxillary ostium, ethmoid infundibulum, and posterior ethmoids will allow for the treatment of moderate disease as well.

STUDY DESIGN

Retrospective data review.

METHODS

A study including all TABD procedures performed between January and December 2009 was performed. Sublabial approach with two working channels, one for the endoscope and a second port for balloon dilatation or other surgical instrumentation, was devised. Both channels were created via mini-trephine aimed toward the osteo-meatal complex (OMC) with different angulations. The same approach was used for transantral posterior ethmoidectomy (TAPE). Data collected included demographics, Sino-Nasal Outcome Test (SNOT) scores, Lund-Mackay score, and complications.

RESULTS

Thirty-five patients with 64 dilated sinuses and 10 TAPE procedures were enrolled. All SNOT scores showed statistically significant improvement decreasing from 1.77 to 0.83. Complication rate was minimal. Only a small number of procedures were converted to standard endoscopic septoplasty (ESS) owing to severity of OMC disease. TAPE proved to be a minimally invasive procedure.

CONCLUSIONS

Two trocars inserted through the canine fossa can achieve a successful result in moderate antral disease for TABD and allow TAPE to be performed, thus creating a bridge between mild disease and one requiring standard full ESS. The minimally invasive approach proved to be particularly useful.