Sinus Surgery

Review the embryology of the paranasal sinuses.

Review the anatomy and physiology of the osteomeatal complex. What are haller cells, onodi cells, aggar nasi cells?

Discuss the anatomy and classification of the frontal sinus cells.

Discuss key landmarks in primary and revision sinus surgery.

What are nasal antral windows and why have they fallen out of favor?

Discuss the indications and approaches to the surgical management of sphenoid sinus disease.

Describe the external approaches to the ethmoid sinuses.

Discuss the surgical management of frontal disease. What is a Draf I, Draf IIA, Draf IIB and Draf III? What is a Lothrop procedure?

List the indications for osteoplastic flap in the management of frontal sinus disease. Describe the procedure.

Discuss informed consent and sinus surgery. List the major and minor complications of FESS.

Reference(s):

Ramakrishnan, V. R., Kingdom, T. T., Nayak, J. V, Hwang, P. H., & Orlandi, R. R. (2012). Nationwide incidence of major complications in endoscopic sinus surgery. International Forum of Allergy & Rhinology, 2(1), 34–39.

When is image guidance indicated for sinus surgery?

How would you manage a post-op orbital hematoma?

While cruising along with a microdebrider during a FESS case, you suddenly notice clear, pulsatile fluid from the posterior ethmoid cavities. How will you manage this complication? What is the appropriate post –operative management?

The middle turbinate: to resect or not to resect?

Reference(s):

Choby, G. W., Hobson, C. E., Lee, S., & Wang, E. W. (2014). Clinical effects of middle turbinate resection after endoscopic sinus surgery: a  systematic review. American Journal of Rhinology & Allergy, 28(6), 502–507.

What is your routine post-operative care after FESS? Will insurance pay for this care?

Reference(s):

Rudmik L, Soler Z.M., Orlandi R.R., Stewart M.G, et. al.(2011). Early postoperative care following endoscopic sinus surgery: an evidence-based review with recommendations. Int Forum Allergy Rhinol 1(6), pp. 417-430.

Thaler E.R. (2002). Postoperative care after endoscopic sinus surgery. Arch Otolaryngol Head Neck Surg, 128(10):1204-6.

Educate us on balloon sinuplasty…indications, safety and outcomes.

Reference(s):

Levy, J. M., Marino, M. J., & McCoul, E. D. (2016). Paranasal Sinus Balloon Catheter Dilation for Treatment of Chronic Rhinosinusitis: A Systematic Review and Meta-analysis. Otolaryngology–Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery, 154(1), 33–40.

When should you use steroid-releasing implants in sinus surgery?

Reference(s):

Rizan, C., & Elhassan, H. A. (2016). Post-sinus surgery insertion of steroid-eluting bioabsorbable intranasal devices: A systematic review. The Laryngoscope, 126(1), 86–92.

What are options for controlling bleeding with sinus surgery? Is epinephrine safe? Is cocaine safe? Warm water?

Reference(s):

Gunaratne D.A., Barham, H.P., Christensen, J.M., Bhatia, D.D., et al. (2016). Topical concentrated epinephrine (1:1000) does not cause acute cardiovascular changes during endoscopic sinus surgery. Int Forum Allergy Rhinol, 6(2):135-9.

Are splints needed after sinus surgery?

Reference(s):

Chan C.L., Elmiyeh, B, Woods, C, Ullah, S, et al. (2015). A randomized controlled trial of a middle meatal silastic stent for reducing adhesions and middle turbinate lateralization following endoscopic sinus surgery. Int Forum Allergy Rhinol, 5(6), 517-23.