Revision sinus surgery

Functional endoscopic sinus surgery has a success rate for symptom improvement of over 90%; however, symptom improvement demonstrates poor correlation with disease resolution and approximately 20% of patients end up requiring revision surgery. Those patients requiring revision sinus surgery therefore fall into a minority but represent a therapeutic challenge for the otolaryngologist [6]. Prior to embarking on revision sinus surgery, a thorough reassessment of the patient's underlying disorder should be conducted. A key concept to remember is that chronic sinusitis is a multifactorial disease, with surgery serving as an adjunct to medical management and control of environmental factors. In addition, continued medical therapy will be necessary in the revision sinus surgery patient even following surgery [7]. Other important issues leading to revision surgery can be classifi ed as general host environmental, and local host factors [5]. In those patients who were an an initial attempt at endoscopic sinus surgery failed, a checklist should be completed evaluating each of these categories before revision surgery (Table 20.1). The categories most amenable to revision sinus surgery are inadequate surgery or postoperative scarring due to either poor operative technique or inadequate postoperative care. Patients who underwent mucosal stripping from prior surgical intervention are at risk for the development of neoosteogenesis, a problem that is very diffi cult or impossible to resolve with revision surgery intervention and appears to be associated with a poorer longterm prognosis and sometimes apparently with persistent pain. The focus of this chapter is revision surgery treatment of infl ammatory sinus disease. The advancements in endoscopic sinus surgery have enabled the vast majority of revision sinus surgery to be conducted using this technique. However, open sinus surgery still has a limited role in revision sinus surgery, its role being largely confi ned to an occasional osteoplastic procedure in patients who fail revision surgery with an extended frontal sinus approach.