Treatment of recurrent barotraumatic and infectious frontal sinusitis by navigated balloon dilation of the nasofrontal duct.

Abstract

Introduction: Recurrent barotraumatic or isolated infectious frontal sinusitis is linked to anatomical variants of the nasofrontal duct (NFD). Anterior ethmoidectomy, the standard treatment, is incomplete in 50-80% of cases, incurring a 19% rate of stenosis. Balloon dilation of the NFD could be an alternative.

Objectives: The primary study objective was to evaluate the safety of the device. The secondary objective was to analyze its long-term efficacy.

Materials and methods: This was a retrospective single-center study including patients treated by NFD enlargement using a navigated dilation balloon. The following data were collected: pre- and post-operative symptoms, preoperative CT scans, follow-up time, return to activities, adverse effects and complications, additional care, and patient satisfaction.

Results: Twenty-one patients were included: 10 with recurrent isolated infectious sinusitis and 11 with recurrent barotraumatic sinusitis (27 frontal sinuses). There was 1 case of eyelid ecchymosis, and no CSF leaks. Mean follow-up was 36.3±38 months. Ninety-one percent of patients were able to resume their activities involving pressure variations. None required hospitalization, repeat consultation or surgical revision. Four patients experienced symptom recurrence, including 2 for reasons other than the frontal sinus. 86% of patients were satisfied with the procedure, 9.5% were indifferent, and only 1 patient was dissatisfied (recurrence of headaches).

Conclusion: Navigated balloon dilation of the NFD was a safe and effective treatment option for these two indications and could replace ethmoidectomy as a first-line procedure.