Sinus revision surgery

Sinus revision surgery, or secondary sinus surgery, is a procedure to address symptoms that remain after an initial sinus surgery. It can also fix new problems related to the initial surgery. The procedure can improve chronic issues, such as nasal pressure, congestion, and breathing problems. Some people have sinus revision surgery years or decades after their first surgery. You may have the same type of surgery as before or a different procedure that uses newer surgical techniques.

Endoscopic sinus surgery is the most common way to perform a revision procedure. A surgeon uses an endoscope (thin tube with a light and camera) to operate through your nostrils, so it doesn’t require any incisions (cuts) in your skin. This minimally invasive approach helps you recover faster and with less pain.

Revision sinus surgery is more complicated than the initial surgery and carries additional risks. That’s why choosing a surgeon with specialized expertise in this procedure is so important.

At Penn Medicine, our fellowship-trained rhinology specialists routinely perform complex sinus revision surgeries with excellent outcomes. They safely and effectively operate near the delicate structures of the eyes and brain and address difficult-to-treat areas of scar tissue. If you’ve had sinus surgery in the past but continue struggling with symptoms that affect your quality of life, we can help.

There can be various reasons why you may need a second sinus surgery. In some cases, the initial diagnosis was incorrect, or the surgeon didn’t use the right surgical technique to address your condition. Blockages in your nose and sinuses, such as nasal polyps, may not have been adequately removed. Nasal polyps can grow back after surgery, making them one of the most common reasons for revision surgery. The initial surgery may also cause problems that need to be addressed in a later procedure, such as scar tissue that blocks your sinuses and causes inflammation or congestion.

Nearly 16 percent of people who have sinus surgery need a revision procedure at some point. The revision rate is lower if an experienced surgeon performs your first procedure. Your risk of needing additional procedures increases if you have asthma, nasal polyps, allergies, or a family history of chronic sinusitis.

Your health-care provider will give you detailed instructions about preparing for sinus revision surgery. You’ll need a physical exam and lab tests to ensure you’re healthy enough for the procedure. You may need to stop taking certain medications, such as blood thinners, a few weeks before surgery. Stop smoking at least three weeks before surgery to reduce the risk of complications.

Sinus revision surgery requires careful planning to locate the areas that need treatment and avoid damage to nearby structures. In addition, the anatomical structures in your nose may have changed from the initial surgery. At Penn Medicine, our rhinologists use advanced preoperative imaging, such as CT scans, MRI, and endoscopy, to make detailed maps of your nose and sinuses before the procedure.

Sinus revision surgery is an outpatient procedure, so you won’t need to stay overnight in a hospital. The length of the procedure varies depending on its complexity. You’ll be under general anesthesia so that you won’t feel any pain, but you will need someone to drive you home.

Here’s what to expect during the sinus revision surgery procedure:

1. Your surgeon inserts an endoscope into your nostril to view the inside of your sinuses.
2. The surgeon uses small instruments to remove scar tissue, diseased bone, polyps, or other blockages.
3. In some cases, your surgeon widens your sinuses to prevent congestion and improve drainage.
4. The surgeon removes the endoscope from your nose. You may have packing in your nose temporarily to control bleeding.

Full recovery from revision sinus surgery can take several months. You may experience pain, swelling, and fatigue for up to a week after your procedure. You can manage discomfort with over-the-counter nonsteroidal anti-inflammatory drugs.

Mild nasal discharge and bleeding are normal, but contact your provider right away if bleeding is heavy. We recommend taking it easy (no heavy lifting or strenuous exercise) for 10 to 14 days after surgery. You’ll have follow-up visits with your surgeon, and they can tell you when it’s safe to return to normal activities.

Potential complications of sinus revision surgery include:

• Adhesions (bands of scar tissue)
• Cerebrospinal fluid leak
• Excessive bleeding
• Infection
• Injury to the skull base or eye sockets
• Vision loss due to optic nerve damage

The rhinology program at Penn Medicine is known regionally and nationally for our experience with complicated and rare sinus and nasal conditions. People throughout the country turn to us for revision sinus surgery and other advanced treatments when other centers have told them they’re out of options. We draw on advanced diagnostics, surgical excellence, and a multispecialty approach to relieve your symptoms and help you enjoy life again.