Advances in Surgery for Chronic Rhinosinusitis

Abstract

Our understanding of chronic rhinosinusitis (CRS) is always evolving with new concepts and technological advancements in order to achieve the best surgical outcomes. 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. 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.