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How-to: Maxillary Access & Dilation

Suggested Tools


Procedure Steps

PREPARE PATH WITH MAXILLARY SEEKERS

1. Use the short leg of the Entellus 120⁰ Maxillary Seeker to reflect the uncinate and create space

2. Use the long leg of the Entellus 135⁰ Maxillary Seeker to cannulate ostium

ACCESS AND DILATE WITH XPRESS

3. Use the supplied XprESS Bending tool to adjust the tip of XprESS LoProfile to the maxillary (M) 135⁰ configuration

4. Start with XprESS positioned tip down

  • TIP--use illumination from the integrated Light Fiber to track tip location behind the uncinate when accessing and removing XprESS
  • Position tip of the Light Fiber flush with the tip of XprESS LoProfile to retain optimal 11 mm leg length

5. Place the XprESS LoProfile elbow high in the middle meatus, with the 11mm leg running adjacent to the uncinate

6. Rotate the device to position the tip behind the uncinate

  • You will note transillumination of uncinate process with Light Fiber, helping track tip position

7. Pull the XprESS LoProfile handle antero-medially so the ball tip rides the backside of the uncinate and deflects the uncinate anteriorly as the ball tip approaches and then cannulates the natural ostium

8. Prior to balloon inflation, ensure the XprESS LoProfile ball tip is fully in the maxillary ostium by placing tension on the XprESS LoProfile handle in an antero-inferior direction so that the inner elbow of the XprESS LoProfile is in contact with the free edge of the uncinate

  • Maintain this position during inflation to prevent the balloon from moving posteriorly during inflation 

9. Inflate balloon, reseat device in ostium, inflate again, deflate

REMOVAL

10. Retract balloon

11. Advance XprESS LoProfile elbow into posterior/superior middle meatus

  • With elbow in posterior/superior meatus, rotate XprESS LoProfile to disengage tip from behind the uncinate process
  • To avoid tearing uncinate process, always visualize tip of XprESS LoProfile device before withdrawing from nose

Maxillary Procedure Pearls

In some instances, anatomy such as a large bulla may prohibit the elbow of the XprESS LoProfile from going posterior enough to get the tip behind the uncinate process when using a "ball tip down" approach. In these instances, use a "ball tip up" approach. See the "February Live Case>>Left Maxillary" video featuring Dr. Gould for an example of this technique.  



IFUs

XprESS

XprESS Indications for Use: To access and treat the frontal recesses, sphenoid sinus ostia, and maxillary sinus ostia/ethmoid infundibula in adults using a trans-nasal approach. The bony sinus outflow tracts are remodeled by balloon displacement of adjacent bone and paranasal sinus structures. Please see the Instructions for Use below for a complete listing of contraindications, warnings, precautions and adverse events.

LED Light Fiber

LED Light Fiber Indications for Use: To locate, illuminate within, and transilluminate across nasal and sinus structures in patients aged 18 and over. Please see Instructions For Use for a complete listing of contraindications, warnings, precautions, and adverse events.