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      Sinusoplastía con balón en seno frontal: Experiencia en 8 pacientes Translated title: Sinuplasty balloon in frontal sinus: Experience in 8 patients

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          Abstract

          Introducción: La sinusoplastia con balón es una técnica cada vez más usada en patología sinusal, ya que previene el trauma, conserva la anatomía, evita la instrumentación del seno frontal, preserva la mucosa del receso frontal, con un alto grado de seguridad. Dentro de sus principales indicaciones se encuentra la patología de seno frontal, como es el caso de sinusitis aislada, osteítis focalizada, sinusitis posoperatoria y barotrauma. Las controversias se relacionan con sus indicaciones limitadas, costo actual elevado y la ausencia de remoción de tejido. Objetivo: Determinar la efectividad de la sinusoplastia con balón en patología del seno frontal. Material y método: Mediante estudio retrospectivo descriptivo se analizan 8 casos clínicos, antecedentes demográficos, indicación quirúrgica, técnica utilizada, seguimiento posoperatorio y complicaciones. Resultados: Ocho pacientes, con edad promedio de 51,4 años. En la mayoría de los pacientes se utilizó balón más técnica quirúrgica endoscópica clásica (7/8). En todos se evidenció permeabilidad del seno frontal posoperatoria y al año de seguimiento. Ningún paciente tuvo complicaciones. El seguimiento promedio fue de 22,2 meses. Conclusiones: La sinuplastía con balón es una técnica segura, siendo una herramienta más, disponible en cirugía nasosinusal. Es especialmente útil en dilatar el receso del seno frontal permitiendo su ventilación y drenaje. El conocimiento anatómico previo es esencial para su correcto uso.

          Translated abstract

          Introduction: Sinuplasty with balloon is a technology increasingly used in sinus pathology, avoiding trauma, and preserving anatomy. It avoids the instrumentation of frontal sinus, and can be realized even in ambulatory form, with high degree of safety. Main indications are the pathologies of frontal sinus, such as isolated sinusitis, focused osteitis, postoperatory sinusitis or barotrauma, where it allows the conservation of the mucose of the frontal recess. Controversies relate to especific indications, cost and the absence of removal tissue. Aim: Asses the effectiveness of balloon sinuplasty in pathology of the frontal sinus. Material and method: Retrospective descriptive study analizing 8 clinical cases, demographic data, surgical indication, technology used, postoperatory follow-up and complications. Results: Eight patients, average age 51,4 years. In the majority of the patients was used balloon and endoscopic surgical (7/8). In all cases technique was demonstrated postoperatory permeability of the frontal sinus. No one patient report complications, with an average follow-up of 22,2 months. Conclusions: Balloon sinuplasty is a sure tool, and is a complementary instrument for nasosinusal surgery, being specially useful in dilatation and ventilation of the frontal recess. Anatomical previous knowledge is essential for its correct use.

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          Most cited references24

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          Safety and outcomes of balloon catheter sinusotomy: a multicenter 24-week analysis in 115 patients.

          The aim of this study was to further evaluate the safety and effectiveness of balloon catheter devices to dilate obstructed sinus ostia/perform sinusotomy. Through a prospective, multicenter evaluation, safety was assessed by rate of adverse events, patency was determined by endoscopic examination, and sinus symptoms were determined by the Sino-Nasal Outcome Test (SNOT 20). At the conclusion of the 24-week analysis, endoscopy determined that the sinusotomy was patent in 80.5% (247 of 307) sinuses and nonpatent in 1.6% (5 of 307), and could not determine ostial patency status in 17.9% (55 of 307). Of the ostia visualized on endoscopy, 98% were patent (247 of 252), while 2% (5 of 252) were considered nonpatent. SNOT 20 scores showed consistent symptomatic improvement over baseline. Revision treatment was required in 3 sinuses (3 of 307 sinuses, 0.98%) in 3 patients (3 of 109 patients, 2.75%). Balloon catheter technology appears safe and effective in relieving ostial obstruction. Patients were pleased and indicated that they experienced symptomatic improvement.
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            Multicenter registry of balloon catheter sinusotomy outcomes for 1,036 patients.

            This study assesses the safety and effectiveness of balloon catheters used as instruments in sinus surgery in a "real-world" multicenter registry of 1,036 patients across 27 US otolaryngology practices. Data were collected by standardized chart review with centralized database administration for all consecutive functional endoscopic sinus surgeries that included the use of balloon catheters across the 18-month time period from December 2005 to May 2007. Balloon catheters were used in 3,276 peripheral (maxillary, frontal, and sphenoid) sinuses, for an average of 3.2 sinuses per patient. There were no major adverse events related to the use of balloon catheter instruments. The revision rate was 1.3% of sinuses treated with a balloon catheter after an average follow-up of 40.2 weeks. Sinus symptoms were improved in 95.2%, unchanged in 3.8%, and worse in 1.0% of patients. Postoperative sinus infections were significantly less frequent and less severe compared to infections before surgery. The results were consistent across all patient categories, including balloon-only patients and revision patients. Use of balloon catheters as instruments in sinus surgery appears to be relatively safe and effective and to improve the patient's quality of life. The results are consistent and generalizable across a wide range of sinusitis patients and physician practices. The complication rates, revision rates, and patient symptom improvement rates all compare favorably with previously reported results of functional endoscopic sinus surgery.
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              Long-term outcome analysis of balloon catheter sinusotomy: two-year follow-up.

              Assess two-year postoperative clinical outcomes for patients receiving balloon catheter sinusotomy. Patients who had sinus ostia dilated with balloon catheters were prospectively evaluated two years after surgery by Sinonasal Outcome Test (SNOT-20) and computed tomographic (CT) scan. Sixty-five patients (195 ballooned sinuses) were followed for two years after surgery, including 34 "balloon-only" patients and 31 "hybrid" patients. SNOT-20 symptom scores were significantly improved from baseline (0.87 vs 2.17 baseline, P < 0.001) and stable compared to six months and one year; this was the case for both balloon-only (1.09 vs 2.09, P < 0.001) and hybrid (0.64 vs 2.26, P < 0.001) patients. Lund-MacKay CT scores were significantly improved from baseline (2.69 vs 9.66, P < 0.001) and stable compared to one year, confirmed for both balloon-only (1.75 vs 5.67, P < 0.015) and hybrid (3.25 vs 12.05, P < 0.001) subsets of patients. A total of 85% of patients reported improvement of their sinus symptoms, with 15% same and 0% worsened. Revision treatment was required in seven of 195 sinuses (3.6%) in six of 65 patients (9.2%). Patients who receive balloon catheter sinusotomy in endoscopic sinus surgery have significant improvement in symptoms two years after surgery. Radiographic evidence also confirms resolution of disease after two years. This demonstrates durability of clinical results previously reported at 24 weeks and one year after surgery.
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                Author and article information

                Journal
                orl
                Revista de otorrinolaringología y cirugía de cabeza y cuello
                Rev. Otorrinolaringol. Cir. Cabeza Cuello
                Sociedad Chilena de Otorrinolaringología, Medicina y Cirugía de Cabeza y Cuello (Santiago, , Chile )
                0718-4816
                December 2010
                : 70
                : 3
                : 215-222
                Affiliations
                [03] orgnameHNO Klinik Universitát Regensburg orgdiv1Servicio de Otorrinolaringología Alemania
                [05] Zurich orgnameUniversidad de Regensburg orgdiv1Hospital Clínico orgdiv2Clínica de Otorrinolaringología Suiza
                [02] orgnameUniversidad de Chile Chile
                [01] orgnameUniversidad de Chile orgdiv1Hospital Clínico orgdiv2Servicio de Otorrinolaringología Chile
                [04] Zurich orgnameORL Zentrum orgdiv1Servicio de Otorrinolaringología Suiza
                Article
                S0718-48162010000300004 S0718-4816(10)07000304
                10.4067/S0718-48162010000300004
                d48e77bd-dc55-4f47-ba87-fe3894026790

                This work is licensed under a Creative Commons Attribution 4.0 International License.

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                Figures: 0, Tables: 0, Equations: 0, References: 16, Pages: 8
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                SciELO Chile

                Categories
                ARTÍCULOS DE INVESTIGACIÓN

                Sinusoplastia,frontal sinus,Sinuplasty balloon,seno frontal,balón

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