Sinus balloon
Sinus balloons are single-use instruments introduced through the nose and placed in the evacuating canal of a sinus to enlarge it by dilating it. Balloons are mainly used for frontal sinuses in France, as these are the most difficult sinuses to treat endonasally. The frontal sinuses are located in line with the eyes, i.e. laterally and very slightly behind the nostril orifices in vertical projection. The orientation of their ˝ nasofrontal˝ drainage channels in the nose is therefore from front to back and from outside to inside, in another sinus, the ethmoid. Surgical opening of the frontal sinus with forceps therefore requires prior opening of the ethmoid sinus with specific instruments and optics. This is a rather delicate procedure, and to limit the risks, only in certain indications can surgical opening with forceps be avoided, and a balloon dilator used instead. The main reasons for dilating the nasofrontal canal are conflicts leading to antibiotic-resistant bacterial sinusitis that cannot drain naturally, and problems of atmospheric pressure equilibrium between the nasal cavity and the sinuses.
Mucoceles, mycoses, benign or malignant tumors are not indications.
Find out more about the use of an endonasal sinus balloon from Dr. Delagranda, ENT and cervico-facial surgeon in La Roche sur Yon.
Frontal sinuses, sinus conflicts
The frontal sinuses are sinuses located above the eyes, often asymmetrical, poorly developed in 4% of cases (hypoplasia) and even absent in 5% of cases (aplasia or agenesis). They arise from an invagination of the ethmoidal sinus at the embryonic stage, which explains why they drain into the ethmoid. Present from birth, they develop most rapidly from the age of 6. Their main roles are to act as a sounding board for the voice, to help warm, humidify and filter the air breathed in, and to lighten the face while giving it the capacity to absorb violent shocks, without affecting the noble organ that is the brain. Indeed, in the event of an accident, an anterior fracture of the frontal sinus is preferable to a perforation of the brain.
The nasofrontal drainage canal is larger than 3 mm, and the frontal ostium smaller than this. The frontal sinus drains directly into the ethmoidal sinus, but in different ways. Occasionally, the drainage zone between several ethmoidal cells is very narrow and, as a result of persistent inflammation, becomes totally blocked. This can lead to acute or chronic sinusitis, which may remain unresolved despite antibiotic and anti-inflammatory treatment, or to pressure pain linked to difficulties in balancing pressure between the nasal cavity and the sinuses. In these cases, traditional opening surgery as described on the frontal sinus page, or the use of balloons, remains the best option.
Who is concerned by endonasal balloon dilatation of the nasofrontal canal?
- Adults with resistant bacterial frontal sinusitis, linked to mucosal conflict.
- Adults with sinus pressure pain linked to difficulties in balancing pressures between nasal cavity and sinus due to mucosal conflict in the “naso frontal” canal.
- Children are very rarely affected by frontal sinus pathologies.
Objectives of the intervention
- Eliminate frontal pain.
- Reduce nasal discharge (anterior and posterior rhinorrhea) and its consequences.
When should nasofrontal balloon dilatation be performed?
Endonasal balloon dilatation of the nasofrontal canal is recommended in cases of :
- Bacterial frontal sinusitis resistant to several lines of usually effective antibiotics, with underlying mucosal impingement. Intense, pulsatile frontal pain, predominant on one side, increased when the head is tilted forward, with or without fever, a runny nose (rhinorrhea), which may or may not be blocked (nasal obstruction) on one side only.
- Sinus pressure pain linked to difficulties in balancing pressures between the nasal cavity and sinuses due to mucosal conflict in the ˝canal naso frontal˝. Frontal pain can be intense, but variable and triggered by sudden variations in atmospheric pressure. These symptoms can be experienced on aircraft during excessively rapid ascents or descents, despite pressurized cabins, but also sometimes simply in the car during mountain journeys with uneven gradients. They can also be experienced by scuba divers.
The different stages of the intervention
The surgical procedure
With no visible external scarring, the procedure is performed through the nasal cavity. Under general anaesthetic in the operating room, the nasal cavity is cleaned with an anaesthetic-retractant, then the balloon is gently inserted into the nasofrontal canal and dilated several times with controlled pressure from the balloon. The balloon is placed in the correct position using anatomical markers and markings on the body of the balloon itself. A further check on correct positioning prior to dilatation can be obtained by transillumination of the frontal sinus or the use of neuronavigation, depending on the balloon model. Unlike surgery with forceps, the aim is not to remove the ethmoidal cell partitions blocking the nasofrontal canal, but to crush them with the balloon, creating microfractures under visual control using rigid optics inserted into the nose. The balloon is not left in place, nor is any other material (no permanent dilator or stent).
Post-surgery recovery period
In the case of outpatient surgery, the patient usually returns home the same day.
After hospitalization, you should rest at home for 2-3 days, and check that there is no bleeding from the nose or throat.
You may be asked to take 3 to 7 days off work, mainly to recover from the general anaesthetic.
Sport is not recommended for the first 7 days, and recovery should be gradual.
Pain is practically non-existent. It is controlled by Class I analgesics.
Post-operative care at home: nosewash with saline, analgesics, antibiotics if required by your doctor.
Scarring: no visible scar.
Complications of nasofrontal balloon dilatation
In addition to the risks inherent in any surgery involving general anesthesia, dilatation of the nasofrontal canal with an endonasal balloon carries the risk of complications, which are very rare:
Nasal haemorrhage (epistaxis) after the procedure: very slight, it rapidly subsides with nose-blowing and nose-washing.
Infection.
Brides responsible for limiting nasal flow.
However, the French ENT College has described exceptional and theoretical complications in balloon sinusplasty, which are more likely to occur with conventional surgery using forceps and burs.
Compressive intra-orbital hematoma.
Double vision (diplopia).
Reduced visual acuity or even blindness.
Cerebrospinal fluid discharge.
Meningitis.
The frontal sinus has the peculiarity of closing slowly, which is not a complication, but an inconstant postoperative evolution that can be embarrassing and necessitate distant surgical revision.
For further information, please consult the ENT College’s explanatory sheet on dilatation of the nasofrontal canal with endonasal balloons.
Frequently asked questions
Here is a selection of questions frequently asked by Dr Delagranda’s patients during consultations for balloon sinusplasty in La Roche-sur-Yon.
Is surgery compulsory?
No, but the decision is made by the patient, often in response to pain.
Is the effect long-lasting?
Yes, but it may be necessary to repeat the procedure in case of recurrence, or to resort to conventional endonasal surgery.
Is it painful?
Hardly ever.
Fees and coverage of the procedure
Endonasal balloon dilatation of the nasofrontal canal is covered by French health insurance. Contact your health insurance company to find out whether any extra fees will be covered.
Do you have a question? Need more information?
Dr Antoine Delagranda is available to answer any questions you may have about nasofrontal balloon dilatation. Dr. Delagranda is a specialist in ENT surgery at the St-Charles clinique, in La Roche sur Yon, France.
ENT consultation for balloon sinusplasty in Vendée
Dr Antoine Delagranda will be happy to answer any questions you may have about balloon sinusplasty. Dr Delagranda is a specialist in ENT surgery at the Clinique Saint Charles in La Roche-sur-Yon in the Vendée.