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Rhinology/Allergy

Revision Frontal Surgery: Pearls and Tips

Monday, October 2, 2023
3:45 PM - 4:45 PM East Coast USA Time
Location: 103BC

    Mentor(s)

  • Devyani Lal, MD

    Professor of Otolaryngology, Division Chair of Rhinology, Dean of Education, Mayo Clinic in Arizona
    Mayo Clinic in Arizona
    Phoenix, AZ, United States

    • Co-Presenter(s)

  • Amar Miglani, MD

    Assistant Professor
    Mayo Clinic - Arizona
    Phoenix, AZ, United States

    • Lead Presenter(s)

  • Peter H. Hwang, MD

    Professor, Vice Chair, Chief
    Stanford School of Medicine
    Palo Alto, CA, United States

Disclosure(s):
Peter H. Hwang, MD: No relevant relationships to disclose.
PROGRAM DESCRIPTION: The narrowness of the fronto-ethmoid region significant individual variation in anatomy and risk of injury to critical adjacent structures create challenges for the sinus surgeon. Incomplete dissection, tissue trauma and middle turbinate medialization are causes that surgeons can control with effective dissection and pre-emptive strategies. Comprehensive dissection of the fronto-ethmoidal region optimizes success, reduces need for revision surgery and sequelae such as mucocele formation. Anatomy guided dissection reduces risk of complications while optimizing surgical outcome. Failed primary surgery can be effectively addressed by a variety of safe and function preserving endoscopic and external techniques. This presentation will address strategies for effective dissection as well as principles and techniques for revision frontal surgery. We will demonstrate anatomy-guided comprehensive & optimal dissection of the frontal sinus drainage pathway by use of CT and endoscopy via standard Draf IIA approach. The course will not address stand-alone balloon techniques. We will explain indications & demonstrate techniques for revision frontal surgery (Draf IIA, Draf IIB, Draf III & "functional" external surgery) The session is tailored to those at least comfortable with Draf I techniques that wish to advance further. The talks will demonstrate the value and application of specialized instrumentation and debridement. The series is taught by two experienced surgeons and a mentored early faculty. It has been very highly rated by past attendees in meeting the learning objectives of surgeons in different stages of expertise.

OUTCOME OBJECTIVE 1: Demonstrate anatomy-guided comprehensive & optimal dissection of the frontal sinus drainage pathway (Draf IIA) by use of CT and endoscopy

OUTCOME OBJECTIVE 2: Explain indications & demonstrate techniques for revision frontal surgery (Draf IIA, Draf IIB, Draf III & "functional" external surgery)

OUTCOME OBJECTIVE 3: Demonstrate application of specialized instrumentation for endoscopic frontal sinus surgery and postoperative debridement

BACKGROUND STATEMENT: The Academy has identified revision sinus surgery as a gap. Practitioners conduct balloon or inadequate endoscopic techniques that result in failure. The lecture is taught by two experienced surgeons and a new mentored early faculty.