- PathAssist 120⁰ and 135⁰ Maxillary Seekers (each seeker has a 8mm short leg and 11mm long leg)
- XprESS LoProfile
- Supplied XprESS Bending Tool
- 30⁰ endoscope (2.7mm or 3.0mm if available)
- Video system, camera, light source and light guide
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
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.
About the Presenting Physicians
Dr. Knox practices in Colorado Springs, CO, at Colorado ENT & Allergy.
He is a Center of Excellence Trainer for Entellus Medical, regularly hosts peers to share insights on office-based procedures, and is the author of "Topical and injected lidocaine with epinephrine provides good anesthesia and excellent hemostasis for in-office sinonasal procedures."
Dr. Loughlin practices in Litchfield, CT at Westood ENT.
Dr. Loughlin is an Entellus trainer, and regularly shares his approach to in-office treatment with visitors at his practice in Connecticut.
Dr. Peters practices in Baton Rouge, LA.
He serves as trainer in the Entellus Center of Excellence peer-to-peer education program, and hosts regular visits to his practice to discuss technique best practices.
Dr. Gould is the founder and director of the St. Louis Sinus Center. He is a Center of Excellence trainer for Entellus, and hosts peers to share his best practices on integrating and performing balloon sinus dilation procedures in the office.
Dr. Gould is the lead author of "In-office, multisinus balloon dilation: 1-Year outcomes from a prospective, multicenter, open label trial," published in March/April 2014 issue of the American Journal of Rhinology & Allergy.
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 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.