Revision Sinus Surgery

Abstract

Chronic rhinosinusitis (CRS) is characterized by persistent symptomatic inflammation of the nasal and paranasal mucosa that lasts longer than 12 weeks. This inflammatory disease of the paranasal sinuses affects 10-15% of US and European populations. CRS patients who are refractory to optimal medical management are candidates for functional endoscopic sinus surgery (FESS). Success rate of FESS may be as high as 90% in Chronic Rhinosinusitis patients without polyps (CRSsNP) and drop to the level of less than 30% in CRS patients with nasal polyps (CRSwNP). Multiple factors contribute to the need for revision endoscopic sinus surgery (RESS) including surgical technique, extent of disease, anatomic obstruction, and postoperative care. When maximal appropriate medical therapy has failed revision surgery must focus on maximizing quality-of-life outcomes. The preoperative analysis begins with a thorough in-office endoscopic examination combined with thin-cut sinus computed tomography scan (axial, coronal, and sagittal views), to allow a triplanar assessment of the postsurgical sinonasal cavities. It is essential to evaluate the most constant standard anatomical landmarks helpful in RESS for the different paranasal sinuses to approach. Postoperative management of RESS is as important as surgery. Postoperative debridments are controversial in the management of scar formation. Irrigations with saline or steroid added irrigations are very helpful for CRS with nasal polyposis. EFRS patients may benefit from systemic steroids for approximately 12 weeks in a tapered fashion. Topical nasal steroids are shown to be effective in randomised clinical trials and continued for a longer time up to 6 months.