Radiologic Analysis of Balloon Sinuplasty in a Human Cadaver Model: Observed Effects on Sinonasal Anatomy

Authors

Erin M. Lopez, The University of North Carolina at Chapel Hill
Zainab Farzal, The University of North Carolina at Chapel Hill
Meghan Norris, The University of North Carolina at Chapel Hill
Michael W. Canfarotta, The University of North Carolina at Chapel Hill
Andrew K. Pappa, The University of North Carolina at Chapel Hill
Griffin D. Santarelli, The University of North Carolina at Chapel HillFollow
Stephen C. Hernandez, The University of North Carolina at Chapel Hill
Brian D. Thorp, The University of North Carolina at Chapel Hill
Brent A. Senior, The University of North Carolina at Chapel Hill
Adam M. Zanation, The University of North Carolina at Chapel Hill
Charles S. Ebert, The University of North Carolina at Chapel Hill
Julia S. Kimbell, The University of North Carolina at Chapel Hill
Adam J. Kimple, The University of North Carolina at Chapel Hill

Document Type

Article

Abstract

Background: Balloon sinuplasty is increasingly used in the outpatient clinic for treatment of chronic rhinosinusitis, but radiologic analysis of its effects on sinonasal anatomy is largely uncharacterized in the known literature. Objective: The purpose of this study is to examine the anatomic effects of balloon sinuplasty in a cadaveric model. Methods: Five fresh cadaver heads underwent sequential endoscopic balloon dilation of maxillary ostia, frontal recess outflow tracts, and sphenoid ostia bilaterally by fellowship-trained rhinologists. Pre- and post-procedural CT imaging was obtained. CT scans were imported into Mimics™ software and sinonasal anatomy was analyzed systematically. Results: Visual confirmation of balloon dilation was achieved in all 3 sites bilaterally in each cadaver. Radiologic analysis demonstrated that the frontal sinus outflow tract was appropriately dilated 60% (6/10 sites) of the time while the agger was inadvertently dilated 30% of the time (3/10). The sphenoid os was successfully dilated 70% (7/10 sites) of the time. In two cases, a posterior sphenoethmoid (Onodi) cell was dilated instead of the sphenoid. Successful dilation of maxillary os was noted 60% of the time (6/10 sites). No significant change in maxillary os was noted after balloon dilation. Normal middle turbinates were significantly medialized following balloon dilation 75% (6/8 sites) of the time. Conclusions: While the goal of balloon sinuplasty is to improve natural sinonasal drainage by dilating existing outflow tracts, as evidenced by radiologic evaluation the procedure appears not to achieve this in all cases, while occasionally creating unintended changes in sinonasal anatomy as well. These unrecognized changes in anatomy may be responsible for the post-procedure change in symptomatology that some patients experience.

Publication Date

1-1-2021

Publication Title

American Journal of Rhinology and Allergy

ISSN

19458924

E-ISSN

19458932

Volume

35

Issue

1

First Page

107

Last Page

113

PubMed ID

32635741

Digital Object Identifier (DOI)

10.1177/1945892420939430

Recommended Citation

Lopez, Erin M.; Farzal, Zainab; Norris, Meghan; Canfarotta, Michael W.; Pappa, Andrew K.; Santarelli, Griffin D.; Hernandez, Stephen C.; Thorp, Brian D.; Senior, Brent A.; Zanation, Adam M.; Ebert, Charles S.; Kimbell, Julia S.; and Kimple, Adam J., "Radiologic Analysis of Balloon Sinuplasty in a Human Cadaver Model: Observed Effects on Sinonasal Anatomy" (2021). Neurology. 591.
https://scholar.barrowneuro.org/neurology/591