Indications for Revision Endoscopic Sinus Surgery

Abstract

• The goal of assessment of the patient with symptoms suggestive of persistent or recurrent sinus disease is to identify the presence of technical, mucosal, and systemic factors contributing to poor outcome by using appropriate investigations.

• The goal of surgery is to improve medical management by reducing disease load and improving access for continuing medical care for those with severe mucosal disease.

• Indications for revision endoscopic sinus surgery can be categorized as follows: (i) incomplete previous surgery, (ii) complications of previous surgery, (iii) recurrent or persistent sinus disease, and (iv) histological evidence of neoplasia. These criteria are not absolute and the decision to reoperate is most often based on clinician judgment and experience.

• The most common technical factors associated with failure of primary surgery are: (i) middle-meatal scarring and lateralization of the middle turbinate, and (ii) frontal sinus obstruction from retained agger nasi or anterior ethmoid cells. These common situations must be actively sought out with endoscopy and radiologic imaging.

• Given the multiple factors that contribute to the persistence of disease, combinations of both medical therapy and surgery may play a role in the continuum of management as the patient’s disease condition evolves over time.

• The patient should be informed that further surgery may be necessary in the future.