Abstract
Purpose of Review
Our understanding of chronic rhinosinusitis (CRS) is always evolving with new concepts and technological advancements in order to achieve the best surgical outcomes.
Recent Findings
The extent of surgery has long been debated and current research has provided surgeons indications to create larger openings for the maxillary and frontal sinus. Historical concerns for larger openings impacting outcomes have been resolved with better understanding of post-operative management. Recent literature advocates the mega-antrostomy in the setting of cystic fibrosis or recalcitrant CRS despite previous standard FESS openings. Draf 3 is known to be used in cases of frontal sinus tumors, CSF leaks, mucoceles, and recalcitrant CRS to standard surgery. Technological advances have had impacted rhinology positively, with a number of in-office procedures becoming more common as well as new intra-operative tools to facilitate surgery. Moreover, post-operatively, the advent of a drug-eluting stent has fastened the healing process following FESS leading to better outcomes.
Summary
Advances in sinus surgery are always evolving. What may have been considered a poor approach in the past are being re-visited with better understanding of CRS and technological advancements.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Desrosiers M, Evans GA, Keith PK, Wright ED, Kaplan A, Bouchard J, et al. Canadian clinical practice guidelines for acute and chronic rhinosinusitis. Allergy Asthma Clin Immunol. 2011;7(1):2.
Thompson CF, Conley DB. What is the optimal maxillary antrostomy size during sinus surgery? Curr Opin Otolaryngol Head Neck Surg. 2015;23(Issue1):34–8.
Cho DY, Hwang PH. Results of endoscopic maxillary mega-antrostomy in recalcitrant maxillary sinusitis. Am J Rhinol. 2008;22:658–62.
Wang EW, Gullung JL, Schlosser RJ. Modified endoscopic medial maxillectomy for recalcitrant chronic maxillary sinusitis. Int Forum Allergy Rhinol. 2011;1:493–7.
Kennedy DW, Shaalan H. Reevaluation of maxillary sinus surgery: experimental study in rabbits. Ann Otol Rhinol Laryngol. 1989;98:901–6.
Phillips PS, Sacks R, Marcells GN, Cohen NA, Harvey RJ. Nasal nitric oxide and sinonasal disease: a systematic review of published evidence. Otolaryngol Head Neck Surg. 2011;144:159–69.
Draf W, Weber R, Keerl R, Constantinidis J. Current aspects of frontal sinus surgery. I: Endonasal frontal sinus drainage in inflammatory diseases of the paranasal sinuses [in German]. HNO. 1995;43:352–7.
Naidoo Y, Bassiouni A, Keen M, Wormald PJ. Long-term outcomes for the endoscopic modified Lothrop/Draf III procedure: a 10-year review. Laryngoscope. 2014;124(Issue 1):43–9.
Tran KN, Beule AG, Singal D, Wormald PJ. Frontal ostium restenosis after the endoscopic modified Lothrop procedure. Laryngoscope. 2007;117(8):1457–62.
•• Knisely A, Barham HP, Harvey RJ, Sacks R. Outside-In Frontal Drill-Out: How I Do It. AMERICAN JOURNAL OF RHINOLOGY & ALLERGY. 2015;29(5):397. This article provides a fast, safe and novel approach to recalcitrant,difficult to treat and challenging frontal sinus conditions.
Edur O, Ozturk K, Erkan K. Feasibility of a septal mucosal flap for preventing restenosis following the Draf III procedure. J Laryngol Otol. 2018;132(1)
Patel VS, Choby G, Shih L-C, Patel ZM, Nayak JV, Hwang PH. Equivalence in outcomes between Draf 2B vs Draf 3 frontal sinusotomy for refractory chronic frontal rhinosinusitis. Int Forum Allergy Rhinol. 2018;8(1):25–31.
Jean Anderson Eloy MD, Alejandro Vázquez MD, Liu JK, MD Soly Baredes MD. Endoscopic approaches to the frontal sinus Modifications of the Existing Techniques and Proposed Classification. Otolaryngol Clin N Am. 2016;49:1007–18.
Eloy JA, Frieden ME, Kuperan AB, et al. Modified mini-Lothrop/extended Draf IIB procedure for contralateral frontal sinus disease: a case series. Int Forum Allergy Rhinol. 2012;2(4):321–4.
Kuhn FA, Church CA, Goldberg AN, Levine HL, Sillers MJ, Vaughan WC, et al. LBalloon catheter sinusotomy: one-year follow-up—outcomes and role in functional endoscopic sinus surgery. Otolaryngol Head Neck Surg. 2008;139:S27–37.
Weiss, Raymond L; Church, Christopher A; Kuhn, Frederick A; Levine, Howard L; Sillers, Michael J; Vaughan, Winston CLong-term outcome analysis of balloon catheter sinusotomy: two-year follow-up. Otolaryngol Head Neck Surg 2008, 139:S38–S46.
Varshney R, Lee JT. New innovations in office-based rhinology. Curr Opin Otolaryngol Head Neck Surg Issue. 2016;24(1):3–9.
Barrow EM, DelGaudio JM. In-office drainage of sinus mucoceles: an alternative to operating-room drainage. Laryngoscope. 2015;125(5):1043–7.
Varshney R, Lee JT. New innovations in office-based rhinology. Curr Opin Otolaryngol Head Neck Surgery Issue. 2016;24(1):3–9.
Gan, Eng Cern; Habib, Al-Rahim R; Hathorn, Iain; Javer, Amin R. The efficacy and safety of an office-based polypectomy with a vacuum powered microdebrider: Vacuum-powered microdebrider. Int Forum Allerg Rhinology, 2013,3(11).
Coblation product brochure. Available at: https://www.smith-nephew.com/ global/assets/pdf/products/surgical/sportsmedicine/08427f%20multi-electrode %20technology%20brochure.pdf.
Choby GW, Hwang PH. Emerging roles of Coblation in rhinology and Skull Base surgery. Otolaryngol Clin N Am. 2017;50:599–606.
Berger G, Ophir D, Pitaro K, Landsberg R. Histopathological changes after coblation inferior turbinate reduction. Arch Otolaryngol Head Neck Surg. 2008;134(8):819–23.
• Passali D, Loglisci M, Politi L, et al. Managing turbinate hypertrophy: coblation vs. radiofrequency treatment. Eur Arch Otorhinolaryngol 2016;273(6):1449–53. This article provides valuable data on the outcomes and efficacy of turbinates management using either coblation or radiofrequency ablation.
Shah AN, Brewster D, Mitzen K, Mullin D. Radiofrequency coblation versus intramural bipolar cautery for the treatment of inferior turbinate hypertrophy. Ann Otol Rhinol Laryngol. 2015;124(9):691–7.
Eloy JA, Walker TJ, Casiano RR, Ruiz JW. Effect of coblation polypectomy on estimated blood loss in endoscopic sinus surgery. Am J Rhinol Allergy. 2009;23(5):535–9.
Stern-Shavit S, Nachalon Y, Leshno M, Soudry E. Middle meatal packing in endoscopic sinus surgery—to pack or not to pack?—a decision-analysis model. Laryngoscope. 2017;127:1506–12.
Murr AH, Smith TL, Hwang PH, Bhattacharyya N, Lanier BJ, Stambaugh JW, et al. Safety and efficacy of a novel bioabsorbable, steroid-eluting sinus stent. Int Forum Allergy Rhinol. 2011;1(1):23–32.
Akbari, E; Philpott, CM; Ostry, AJ; Clark, A; Javer, AR. A double-blind randomised controlled trial of gloved versus ungloved merocel middle meatal spacers for endoscopic sinus surgery. RHINOLOGY, 09/2012, Volume 50, Issue 3.
Forwith KD, Chandra RK, Yun PT, Miller SK, Jampel HD. ADVANCE: a multisite trial of bioabsorbable steroid-eluting sinus implants. Laryngoscope. 2011;121(11):2473–80.
Lavigne F, Miller SK, Gould AR, Lanier BJ, Romett JL. Steroid-eluting sinus implant for in-office treatment of recurrent nasal polyposis: a prospective, multicenter study. Int Forum Allergy Rhinol. 2014;4(5):381–9.
Han JK, Forwith SD, Smith TL, et al. RESOLVE: a randomized, controlled, blinded study of bioabsorbable steroid-eluting sinus implants for in-office treatment of recurrent sinonasal polyposis. Int Forum Allergy Rhinol. 2014;4(11):861–70.
Dalgorf DM, Sacks R, Wormald PJ, Naidoo Y, Panizza B, Uren B, et al. Image-guided surgery influences perioperative morbidity from endoscopic sinus surgery: a systematic review and meta-analysis. Otolaryngol Head Neck Surg. 2013;149(1):17–29.
Citardi MJ, Agbetoba A, Bigcas JL, Luong A. Augmented reality for endoscopic sinus surgery with surgical navigation: a cadaver study. Int Forum Allergy Rhinol. 2016;6(5):523–8.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no competing interests.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Additional information
This article is part of the Topical Collection on RHINOLOGY: Chronic Rhinosinusitis
Rights and permissions
About this article
Cite this article
Al-Salman, R., Thamboo, A. Advances in Surgery for Chronic Rhinosinusitis. Curr Otorhinolaryngol Rep 6, 239–244 (2018). https://doi.org/10.1007/s40136-018-0210-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40136-018-0210-8