Endoscopically Guided Balloon Dilatation of Recurrent Choanal Stenosis

Abstract

Balloon Sinuplasty is a treatment modality, which has gained much attention since its introduction in 2005. Nasal and paranasal sinus disease can be treated with this new method in a less traumatic way than by Functional Endoscopic Sinus Surgery (FESS) or conventional sinus surgery. One of the advantages of Balloon Sinuplasty is the preservation of anatomical structures within the nose. Also there is no loss of mucosal lining, i.e. ciliated nasal epithelium normally remains intact. The basic principle is to place a balloon catheter (Fig. 1) via a guidewire into a sinus ostium, to inflate the balloon and thus to dilate the sinus ostium. Improved ventilation and drainage of the sinus via the dilated ostium ensures healing of the diseased cavity. Dilatation catheters, which are now being used in Rhinology derive from vascular medicine, where these devices are used to open occluded or partially occluded arteries. In this field dilatation catheters have led to significant reduction of operative trauma compared to conventional vascular surgery. FESS currently is the gold standard in the treatment of recurrent sinusitis, if conservative therapy fails to achieve a permanent relief. It provides good results with acceptable discomfort for the patient. In most cases postoperative packing is necessary after FESS to stop nasal bleeding. Packing is uncomfortable for the patient and thus there are ongoing endeavours to develop even less traumatic methods to treat nasal diseases than FESS. Balloon dilatation is supposed to have the following benefits compared to FESS: less bleeding, more tissue preservation, less trauma to surrounding tissue, less complications, faster patient recovery and less postoperative care. Initially all Balloon Sinuplasty procedures were performed under fluoroscopy. This fact was bound to technical prerequisites, which not every ENT-Department was able to provide. In addition exposure of patients and surgeons to X-rays during the procedure was a matter of continuous debate, especially in paediatric patients. This problem was overcome, when the LUMATM technology was developed and catheters could be placed into the respective sinuses under endoscopic and diaphanoscopic control. We decided to use this technique for the restoration of the nasal airway passage in a child with recurrent choanal atresia. At the explicit wish of the parents no conventional surgery or FESS procedure was carried out. The parents reported, that the first operation had severely traumatized the child, therefore the parents asked for the least traumatic method, which was likely to give the child relief of his complaints.