We talk with Rhinologist Dr. Ashleigh Halderman about Revision Endoscopic Sinus Surgery, including patient selection, pre-op planning, and endoscopic technique.

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SHOW NOTES

In this episode, Dr. Ashleigh Halderman joins Dr. Gopi Shah and Dr. Ashley Agan to discuss preoperative, procedural, and postoperative considerations for revision sinus surgery.

Dr. Halderman begins by describing her patient workup, which includes learning about the patient’s history with sinus problems and surgeries. It is critical to learn about the patient’s current maintenance regimen and whether it includes sinus rinses, steroids, and/or antibiotics. Dr. Halderman aims to teach patients how to maximize medical management techniques before performing a revision surgery. She discusses the steroids and antibiotics that she usually prescribes and her patient education technique for nasal rinses.

In addition, she conducts physical and endoscopic exams and obtains a preoperative CAT scan. She emphasizes that the CAT scan is important for determining the extent of the prior surgery and guiding future plans. Sometimes, the scan reveals that a patient’s symptoms are not sinus-driven (i.e. recurrent viral infections), leading her to consider options besides surgery.

Finally, the doctors discuss operative technique. Revision surgeries may be challenging due to abnormal anatomy and scarring, so Dr. Halderman advises surgeons to utilize image guidance and look for anatomical landmarks.

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RESOURCES

The International Frontal Sinus Anatomy Classification (IFAC) and Classification of the Extent of Endoscopic Frontal Sinus Surgery:
https://pubmed.ncbi.nlm.nih.gov/26991922/