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Rhinology/Allergy

Revision Sinus Surgery: When, Why, How?

Tuesday, October 3, 2023
3:30 PM - 4:30 PM East Coast USA Time
Location: 103BC

    Moderator(s)

  • Li-Xing Man, MSc, MD, MPA, FARS

    Associate Professor and Residency Program Director of Otolaryngology Head and Neck Surgery
    University of Rochester Medical Center
    Rochester, NY, United States

    • Panelist(s)

  • VL

    Victoria S. Lee, MD

    Assistant Professor of Otolaryngology, Director of Rhinology Research
    University of Illinois Chicago
    Chicago, IL, United States

  • Edward D. McCoul, MD, MPH

    Professor
    Ochsner Clinic
    New Orleans, Louisiana, United States

  • George A. Scangas, MD

    Assistant Professor of Otolaryngology
    Harvard Medical School
    Lynnfield, MA, United States

Disclosure(s):
Li-Xing Man, MSc, MD, MPA, FARS: No relevant relationships to disclose.
Victoria S. Lee, MD: No relevant relationships to disclose.
George A. Scangas, MD: No relevant relationships to disclose.
PROGRAM DESCRIPTION: Decision-making for choosing when to perform revision endoscopic sinus surgery is increasingly complicated given the availability of new medical treatments such as innovative methods for steroid delivery and biologics targeting inflammation. Through case-based examples, this session shows how the use of available data affects decision-making for revision endoscopic sinus surgery. We will address anatomic factors—including paranasal sinus mucoceles, residual uncinate process, maxillary sinus recirculation, middle turbinate lateralization, frontal and sphenoid ostial stenosis, and frontal recess neo-osteogenesis—seen on sinonasal imaging and endoscopy that suggest revision endoscopic sinus surgery success. The comprehensive otolaryngologist, advanced practice provider, and otolaryngologist-in-training will learn to utilize patient characteristics and anatomic findings to inform the decision for revision endoscopic sinus surgery versus more intensive medical management. The role of biologics in the management of the refractory sinus patient will be specifically discussed. Cases will illustrate the evidence for treating nasal polyposis with topical medications versus biologics versus revision endoscopic sinus surgery. We will also discuss tools of revision surgery, including image guidance, augmented reality, balloon sinus dilation, and powered instrumentation. Surgical techniques and maneuvers for addressing common anatomic problems seen in the refractory chronic rhinosinusitis patient are described.

OUTCOME OBJECTIVE 1: Recognize and interpret sinonasal imaging and endoscopy findings that favor greater success of revision endoscopic sinus surgery versus alternative treatment options.

OUTCOME OBJECTIVE 2: Understand factors that help the clinician recommend topical corticosteroids, biologics, or revision surgery in the refractory nasal polyposis patient.

OUTCOME OBJECTIVE 3: Describe and implement surgical maneuvers to address common anatomic problems encountered in revision endoscopic sinus surgery.

BACKGROUND STATEMENT: We shall address the need for a nuanced, data-driven approach to managing the refractory chronic rhinosinusitis patient, including an emphasis on indications for revision endoscopic sinus surgery versus medical management, including the role biologics.