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Surgical Instructions in Revision Endoscopic Sinus Surgery: Pearls and Pitfalls

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Abstract

Functional endoscopic sinus surgery (FESS) has become one of the most common surgical techniques performed by otolaryngologists with significant data demonstrating its efficacy in managing patients with chronic rhinosinusitis (CRS). However, despite this initial success, patients may continue to present with recurrent symptoms and approximately 10–15% of them will require revision surgery. Failure of FESS may have many different causes which include inappropriate patient selection and preparation, comorbidities like cystic fibrosis and Samter’s triad, insufficient surgical skills or anatomical variations that have not been addressed adequately. Two inverse European techniques were introduced in the 1980s. The one promoted by Messer–klinger, who practiced the anterior-to-posterior approach, another one, developed by Wigand who performed posterior-to-anterior dissection, opens the sphenoid ostium or removes the anterior wall of the sphenoid sinus and ends with a total ethmoidectomy. Hereby in RESS we start dissection in posterior-to-anterior fashion by following a structured approach in the identification of the fixed landmarks to allow quick and easy orientation to the skull base and medial orbital wall to avoid the complications.

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No funding was received for the current study.

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Authors and Affiliations

  1. Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Surgery, College of Medicine, Sulaymaniyah Teaching Hospital, University of Sulaymaniyah, Sulaymaniyah, Kurdistan, Iraq

    Muaid I. Aziz Baban

  2. Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy

    Muaid I. Aziz Baban, Paolo Castelnuovo, Mokarbesh Hadi, Apostolos Karligkiotis, Paolo Battaglia & Abdulrahman Shawkat

  3. Head and Neck Surgery & Forensic Dissection Research Center (HNS & FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy

    Paolo Castelnuovo, Apostolos Karligkiotis & Paolo Battaglia

  4. Unit of Otorhinolaryngology, Prince Mohammed Bin Naser Hospital, Jazan, Saudi Arabia

    Mokarbesh Hadi

Authors
  1. Muaid I. Aziz Baban
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  2. Paolo Castelnuovo
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  3. Mokarbesh Hadi
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  4. Apostolos Karligkiotis
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  5. Paolo Battaglia
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  6. Abdulrahman Shawkat
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Correspondence to Muaid I. Aziz Baban.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Trans-rostral approach to the sphenoid sinus: by drawing an imaginary line from the level of the tail of the supreme or superior turbinate to the septum intersect with a vertical line drown from the floor of the septum and drill over it to open the sphenoid sinus. (AVI 10699 kb)

Medial to lateral (draf III) approach to the frontal sinus (part 1): showing identification of the first branch of the anterior ethmoidal artery and first olfactory fiber by an inverted U shape incision in the roof of the nasal cavity starting 1–1.5 cm behind the remnant of the anterior end of the middle turbinate extending laterally over NLD area and medially over the superior part of the septum. (AVI 8318 kb)

Medial to lateral (draf III) approach to the frontal sinus (part 2): shows septectomy, bilateral frontal sinusotomy. (AVI 9852 kb)

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Baban, M.I.A., Castelnuovo, P., Hadi, M. et al. Surgical Instructions in Revision Endoscopic Sinus Surgery: Pearls and Pitfalls. Indian J Otolaryngol Head Neck Surg 74 (Suppl 2), 813–820 (2022). https://doi.org/10.1007/s12070-020-01861-6

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  • DOI: https://doi.org/10.1007/s12070-020-01861-6

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