Abstract
The key points in the performance of revision surgery for chronic sinusitis are the mental state of the patient, the morphological changes, and the pathological condition. Revision surgery is mainly performed for cases with insufficient primary surgery, recurrent frontal sinusitis and eosinophilic rhinosinusitis. As for the reoperation, the procedure is more complex than the primary operation, especially because of diverse factors including patient-related and disease-related issues.
The key points pertaining to the surgery are as follows;
1. All sinuses must be opened and a single cavity, as wide as possible, must be made.
2. The difficulty in the procedure depends on the number of turbinates and agger nasi remaining.
3. The frontal and the sphenoid sinus should be surgically opened as landmarks, even if there are no pathological lesions.
4. There are limitations to the treatment of the pathological mucosa in the frontal sinus.
5. When the extent of the pathological involvement of the mucosa in the olfactory cleft is severe, excessive resection should not be performed to avoid mucosal adhesion after surgery.
6. Pathological mucosa should be completely removed using a microdebrider or several surgical forceps.
7. Bleeding and edema of the mucosa are less severe when antibiotics and systemic steroids are administered before the operation.
Although long-term observation after reoperation in cases with recurrent disease have indicated satisfactory results, some 8% of all re-operated cases of eosinophilic rhinosinusitis required re-revision surgery.
With advances in the diagnostic imaging techniques, in medical devices such as endoscopes and navigation systems, and the pathological diagnostic techniques, revision surgery can be performed precisely and safely, and the outcomes of the patients are thought to have improved.
