Tajudeen Bobby A, Gupta Sanjay, Willoughby Brian, Kennedy David W
Department of Otorhinolarygology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL.
Front Range Ear, Nose & Throat or Front Range ENT, PC.
Int Forum Allergy Rhinol. 2017 Aug;7(8):794-800. doi: 10.1002/alr.21957. Epub 2017 Jun 2.
Topical solutions to the sinus cavity are primarily administered via a transnasal route with inherent limitations of distribution. Here we describe an alternate method of sinus access via lacrimal sinus diversion using a novel lacrimal diversion device (LDD).
A cadaveric study was performed using 12 disarticulated fresh heads. The LDD was implanted in 23 sides meeting insertion criteria. Time to placement was recorded and patency was assessed via nasal endoscopy. Methylene blue was administered via the LDD and 16 sides underwent surgical ethmoidectomy to assess distribution of mucosal staining. Four cadavers underwent computed tomography (CT) imaging to demonstrate stent position.
Mean time of placement was 3.66 ± 2.37 minutes (mean ± standard deviation [SD]). Patency rate was 100%. Six sides (37.5%) had anterior ethmoid staining, 6 sides (37.5%) had posterior ethmoid staining, and the remaining 4 sides (25%) had mixed anterior and posterior ethmoid staining. Stents placed optimally resulted in anterior ethmoid staining without complication. Malpositioned stents resulted in posterior ethmoid staining and some inadvertent ethmoid vertical lamella trauma in 2 instances.
Sinus irrigation can be delivered to the ethmoid sinuses directly via a lacrimal diversion stent. Technique modification or image guidance may be helpful in ensuring optimal placement.
鼻窦腔局部用药主要通过经鼻途径给药，但其分布存在固有局限性。在此，我们描述一种通过使用新型泪道改道装置（LDD）经泪道改道进入鼻窦的替代方法。
使用12个离体新鲜头颅进行尸体研究。将LDD植入符合插入标准的23侧。记录放置时间，并通过鼻内镜评估通畅情况。通过LDD注入亚甲蓝，对16侧进行手术筛窦切除术以评估黏膜染色分布。对4具尸体进行计算机断层扫描（CT）成像以显示支架位置。
平均放置时间为3.66±2.37分钟（平均值±标准差[SD]）。通畅率为100%。6侧（37.5%）有筛窦前群染色，6侧（37.5%）有筛窦后群染色，其余4侧（25%）有筛窦前群和后群混合染色。放置最佳的支架导致筛窦前群染色且无并发症。位置不当的支架导致筛窦后群染色，2例出现一些意外的筛骨垂直板损伤。
可通过泪道改道支架直接将鼻窦冲洗液输送至筛窦。技术改进或图像引导可能有助于确保最佳放置。
