Tips and pearls in revision sinus surgery

Successful revision endoscopic sinus surgery starts with proper patient selection and medical management of comorbidities and environmental influences. • Preoperative planning in at least two and preferably three computed tomography planes is needed in order to plan the surgical approach and identify problem areas. • A complete sphenoethmoidectomy is the best procedure for long-term success. • A surgical approach is most safely done when identifying the medial orbital wall, roof of the maxillary sinus, and skull base posteriorly within the sphenoid sinus. • All bony fragments should be removed from their attachment along the medial orbital wall, skull base, and frontal recess. • As with primary surgery, the mucoperiosteum should be preserved. • Nearly as important as a good technical surgery is meticulous long-term postoperative debridements and surveillance to ensure patency and mucosal health.