Balloon sinuplasty (frontal sinus)
A keyhole technique to gently open the frontal sinus drainage channel using a small balloon, used selectively for isolated frontal disease.
Balloon sinuplasty opens a blocked sinus drainage pathway by passing a fine catheter through the natural opening and inflating a small balloon to widen it. The lining is preserved rather than removed. Mr Gane mainly uses it for the frontal sinus, where the drainage channel is narrow and complex and where conventional surgery can scar and re-narrow. For most other sinus problems, endoscopic sinus surgery is the right operation, and Mr Gane will recommend the one that fits the disease rather than the device.
When it is useful
- Recurrent or persistent frontal sinusitis, particularly when the rest of the sinuses are quiet
- Frontal recess narrowing after previous sinus surgery, where the aim is to re-open the channel without disrupting the surrounding lining
- Isolated frontal disease where a more extensive operation would be over-treatment
When it is not the right operation
Balloon sinuplasty does not remove polyp tissue, does not open the ethmoid cells and does not treat widespread sinus mucosal disease. If polyps, ethmoiditis or pansinusitis are present, endoscopic sinus surgery is more appropriate. The two procedures are sometimes combined: balloon for the frontal, endoscopic surgery for the rest.
What it involves
- Day case under general anaesthetic
- Performed entirely through the nostril with the endoscope, so no cuts or bruising on the face
- A guide wire and small balloon catheter are passed into the frontal sinus opening under direct vision
- The balloon is inflated briefly to dilate the channel, then removed
- Usually 20 to 40 minutes per side; no nasal packing is needed
Recovery
- Bleeding is usually less than with conventional sinus surgery
- A blocked-nose feeling for a few days; saline rinses are started the day after
- Most people are back to office work within a week
- A nasal steroid spray and short course of rinses are continued at home
Risks
Risks are uncommon but include bleeding, infection and failure to keep the sinus open, with a small proportion of frontal balloon procedures eventually needing conversion to conventional surgery. Because the frontal sinus sits beneath the floor of the skull and behind the orbit, very rare risks include orbital injury and a leak of fluid from around the brain; in experienced hands these are well below 1 in 1,000 and are discussed in full before you decide to go ahead.
Evidence
NICE interventional procedure guidance (IPG496) and a growing body of randomised and registry data support balloon sinus dilation for selected patients with chronic rhinosinusitis without polyps. Outcomes are best where the procedure is matched to the right anatomy and the right disease.
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This page is general information and not a substitute for individual medical advice. The right treatment depends on your assessment.