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Delivering irrigation to the anterior ethmoid region: evaluation of a lacrimal diversion device in a cadaver model
Author(s) -
Tajudeen Bobby A.,
Gupta Sanjay,
Willoughby Brian,
Kennedy David W.
Publication year - 2017
Publication title -
international forum of allergy and rhinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.503
H-Index - 46
eISSN - 2042-6984
pISSN - 2042-6976
DOI - 10.1002/alr.21957
Subject(s) - medicine , cadaveric spasm , cadaver , ethmoidectomy , stent , ablation , surgery , nasal cavity , ethmoid sinus , sinus (botany) , radiofrequency ablation , anatomy , maxillary sinus , sinusitis , botany , biology , genus
Background Topical solutions to the sinus cavity are primarily administered via a transnasal route with inherent limitations of distribution. Here we describe an alternate method of sinus access via lacrimal sinus diversion using a novel lacrimal diversion device (LDD). Methods A cadaveric study was performed using 12 disarticulated fresh heads. The LDD was implanted in 23 sides meeting insertion criteria. Time to placement was recorded and patency was assessed via nasal endoscopy. Methylene blue was administered via the LDD and 16 sides underwent surgical ethmoidectomy to assess distribution of mucosal staining. Four cadavers underwent computed tomography (CT) imaging to demonstrate stent position. Results Mean time of placement was 3.66 ± 2.37 minutes (mean ± standard deviation [SD]). Patency rate was 100%. Six sides (37.5%) had anterior ethmoid staining, 6 sides (37.5%) had posterior ethmoid staining, and the remaining 4 sides (25%) had mixed anterior and posterior ethmoid staining. Stents placed optimally resulted in anterior ethmoid staining without complication. Malpositioned stents resulted in posterior ethmoid staining and some inadvertent ethmoid vertical lamella trauma in 2 instances. Conclusion Sinus irrigation can be delivered to the ethmoid sinuses directly via a lacrimal diversion stent. Technique modification or image guidance may be helpful in ensuring optimal placement.