Revision Endoscopic Sinus Surgery

[Ashleigh Halderman MD]
Well, I said, regular debridements are crucial. And so I'll see a person for one week after surgery and clean out as much as I can. And then I'll see them a week or two after that. And that's really, really critical. I've also started putting patients on budesonide rinses in about the first or second postoperative appointment. Because I think it just helps with the healing, helps cut down some of that inflammatory reaction that you typically see in the sinuses after surgery. I mean, these are in non-polyp patients and polyp patients alike. And it avoids oral steroids, which is great and it just acts topically.

I don't do antibiotics for every patient after surgery. I'll see how they're doing and if I see some gunky look and stuff, I'll give them doxycycline but only if I see that. And if they're not rinsing, you can tell and I'll have a very frank conversation with them about that. And then usually I'll arrange a shorter term follow up to make sure that things are heading in the right direction.

But I think key takeaways, number one, make sure the right diagnosis was made. Number two, make sure that you understand the anatomy to the best of your ability after reviewing your imaging in great detail. Number three, utilize the best technique possible as you're doing the surgery itself. And by that, I mean a complete surgery with removal of all the ethmoid partitions, identifying the lamina and the skull base and preserving mucosa and that's a huge one. You strip the mucosa and that is going to always be a problem area. And then regular care and follow up with rinses and debridements is absolutely crucial. So I think those are the main highlights as far as how to be successful with revision cases.