Endoscopically guided removal of bridging tissue between ostia can alleviate sinusitis, congestion, and other symptoms caused by mucous recirculation.
In patients with normal physiology, clia propel mucous from various sinuses through the ostia to the nasopharynx, where it is swallowed. Recirculation—circular movement of the mucus blanket in a paranasal sinus due to the presence of an extra ostium—can cause persistent rhinosinusitis in either the pre- or post-surgical patients. About 4% of patients have an extra ostium, and most of these patients report trouble clearing sinus secretions and postnasal drip. Their sinuses may be otherwise clear. Surgical intervention involves removing bridging tissues so the surgical ostium can connect to the natural ostium, restoring normal sinus drainage.
Most patients have been admitted for surgery for this procedure, but a team of surgeons from Emory University School of Medicine reports that surgeons can perform this procedure in the office. They have published a prospective case series in the International Forum of Allergy & Rhinology’s advance electronic publications.
This case series includes 10 patients endoscopically-diagnosed with recirculation between 2009 and 2014, 9 involving the maxillary sinus and 1 involving the sphenoid. All patients had had previous sinus surgery. Patients reported facial pressure, mucus stasis, congestion, and recurrent sinusitis.
The surgeons treated patients in the office, using topical anesthesia for all patients and adding local anesthesia for the four patients who had a bone component. They removed the bridging tissues between ostia using through-cutting forceps and an endoscope. This publication includes before-and-after endoscopic views of surgical sites from four cases.
All patients reported significant improvement or complete symptom resolution and the surgeons found no further endoscopic evidence of mucus recirculation 4 weeks after surgery.
The surgeons indicate that performing this procedure in the office can decrease risk, cost, and time associated with an operating suite procedure. They demonstrate that they successfully treated patients, even when bony structures were involved. This leads to significant savings to the healthcare system and less missed work/school compared to an operating room procedure. In-office surgery for recirculation is possible, even when there is significant intervening bone.