Coakley trocar used in this procedure. Above - the cannula, below - the sharp end of the device use to prick and make the opening of the medial wall of the antrum.
Attached cannula sleeved into the trocar. The trocar will be removed and the sleeve left in place for irrigation once antral cavity placement of the tip confirmed.
Snapshot of Coakley trocar in-situ (arrow) with its tip inside the maxillary sinus.
(S - septum, IT - inferior turbinate)
The puncture wound (arrow) at completion of procedure which will close naturally upon healing. (S - septum, IT -inferior turbinate)
Figure 1: Endoscopic view prior to balloon procedure.
Figure 2: Balloon sinuplasty being performed using SPIN system and LUMA guidewire.
Figure 3: Mucopus and infectious material being flushed out.
Figure 4: Procedure completed once the exited saline from dilated ostium becomes clear.
MT - middle turbinate, S - nasal septum, dashed line - uncinate process surface anatomy, star - mucopus, X - saline irrigation exited from dilated ostium. NB: this patient had endoscopic sinus surgery years ago and has recurrent infection.
An illumination of right maxillary sinus for confirmation of correct entry and positioning before the balloon andvancement and inflation. Similar illumination is seen in frontal sinus but least visible in sphenoid sinus.
An example of microdebrider by Medtronic
This device is has becomes widely-used during endoscopic nasal surgery and very useful in removing mass lesions including polyps. Specimen can be collected by siphoning the debrided materials into a collector bottle attached to the suction tube. It is an alternative biopsy method to cold instrument usage.
Microdebrider tip showing the inner rotating serrated blade
in "close" [left figure] and "open" position [right figure].
Biopsy was taken prior to polyps removal.
Figure shows polyp of left frontal sinus (P) surrounded by hyperplastic mucosa (+).