Transantral balloon dilation plus posterior ethmoidectomy

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.

Retrospective data review.

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.

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.

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.