Revision frontal sinusotomy using stepwise balloon dilation and powered instrumentation

Objectives/Hypothesis: To report a novel approach toward revision frontal sinusotomy using a technique of balloon dilation followed by the use of powered instrumentation. Study Design: Case report. Methods: The frontal sinus outflow tract location was first confirmed with image guidance and then dilated with a balloon to address the soft tissue stenosis. Subsequently, the drill was introduced to accomplish a Draf 2B frontal sinusotomy. Results: An advantage of initial balloon dilation of the frontal sinus outflow tract was to quickly address the soft tissue stenosis with minimal tissue trauma and therefore less bleeding. This subsequently enabled insertion and clear visualization of the entire drill bit within the inferior aspect of the frontal outflow tract. The increased visualization makes other instrumentation safer as well, and avoids relatively blind removal of scar tissue that could result in inadvertent entry into the orbit or skull base. Conclusions: We describe the utility of the balloon as a tool for revision frontal sinusotomy to efficiently and safely allow subsequent instrumentation of the frontal outflow tract with larger more aggressive instruments, such as the drill. We have found this to be a safe and effective technique provided proper preoperative patient selection and assessment for limiting factors.