Ultrasonography in a nasal cavity filled with water during endoscopic sinus surgery

We developed a new ultrasonographic imaging technique to be used in a water-filled nasal cavity during endoscopic sinus surgery, and estimated how well surgically dangerous sites were depicted. Our newly developed balloon can completely fill the choana, preventing water from leaking into the pharynx. The balloon enables endoscopic sinus surgery to be relatively safely performed in "flowing water." Fifteen patients with chronic sinusitis underwent endoscopic sinus surgery under local anesthesia, and a MicroTip Radial probe was inserted into the water-filled nasal cavity. The orbital contents, skull base, and maxillary sinuses were visualized in all cases. Even in cases with a thin lamina papyracea, the boundary of the orbit could be judged from the motion of the orbital contents. Ultrasound information obtained in real time will be useful for improving the safety of endoscopic sinus surgery. Our ultrasonographic imaging technique can provide an early warning to the surgeon and thereby prevent severe complications.