Enhanced Irrigant Delivery to the Ethmoid Sinuses Directly Following Ethmoid Punch Sinusotomy

Waleed M. Abuzeid, Asa Z. Peterson, Aakanksha Rathor, Jordan C. Xu, Nathalia Velasquez, Ali R. Rashan, Andrew Thamboo, Jayakar V. Nayak

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objectives: Ethmoid punch sinusotomy (EPS) is a feasible treatment for ethmoid sinusitis in a subset of chronic rhinosinusitis (CRS) patients per a recent report. This adjunctive work investigates the technical characteristics of EPS and determines if EPS measurably alters the topical delivery of irrigant into the ethmoid sinuses in a cadaveric model. Methods: The sinonasal cavities of 10 human cadaver heads were irrigated with a solution containing methylene blue and radio-opaque contrast prior to and following EPS. Procedural characteristics and irrigant distribution were assessed by endoscopy and computed tomography. Results: Forty EPS procedures were performed through the ethmoid bulla and basal lamella. Compared to controls, EPS enhanced dye distribution into the anterior (90% vs 35%, P <.004) and posterior (90% vs 35%, P <.002) ethmoid sinuses, representing a 157% increase for each of these sites. Contrast was detected in a higher proportion of anterior (65% vs 5%, P <.001) and posterior (60% vs 0%, P <.001) ethmoid sinuses. Endoscopically guided catheter instillation of contrast through the EPS sites achieved radiotracer distribution throughout the ethmoid complex. Conclusions: Ethmoid punch sinusotomy sites can be reliably created via micro-minimally invasive procedures. Ethmoid punch sinusotomy improves irrigant delivery to the ethmoid sinuses, providing mechanistic understanding for the clinical outcomes observed in CRS patients.

Original languageEnglish (US)
Pages (from-to)804-812
Number of pages9
JournalAnnals of Otology, Rhinology and Laryngology
Issue number12
StatePublished - Dec 1 2017


  • CRS
  • balloon catheter dilation
  • balloon sinuplasty
  • chronic rhinosinusitis
  • drug delivery
  • ethmoid sinusitis
  • minimally invasive surgical procedures
  • sinus ventilation
  • topical drug administration

ASJC Scopus subject areas

  • Otorhinolaryngology


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