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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5226_Библиотеки_им_академика_М_И_Перельмана.pdf
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- •Preface
- •Contents
- •Contributors
- •Extrinsic Factors
- •Intrinsic Factors
- •References
- •Indications
- •Surgical Technique
- •References
- •Background
- •Preoperative Considerations
- •Other Operative Points
- •Surgical Indications
- •Surgical Technique (Video 3.1)
- •Reported Outcomes
- •Potential Complications
- •References
- •4: Endoscopic Denker’s Approach
- •Background
- •Surgical Technique
- •Reported Outcomes
- •References
- •Background
- •Reported Outcomes
- •References
- •Background
- •Surgical Indications
- •Surgical Technique
- •Reported Outcomes
- •References
- •Background
- •Technical Factors
- •Patient Factors
- •Anatomic Factors
- •Imaging Review
- •Surgical Technique
- •Draf IIA
- •Draf IIB (Video 7.2)
- •References
- •Background
- •Surgical Techniques
- •Standard Frontal Sinus Approaches
- •Modified Hemi-Lothrop Procedure (Eloy IIC)
- •Modified Mini-Lothrop Procedure (Eloy IID)
- •Modified Subtotal-Lothrop Procedure (Eloy IIE)
- •Modified Central-Lothrop Procedure (Eloy IIF)
- •References
- •Background
- •Surgical Techniques
- •Modifications
- •Reported Outcomes
- •References
- •Background
- •Surgical Technique
- •References
- •11: The Outside-in Draf III Procedure
- •Background
- •Surgical Technique
- •Surgical Steps
- •Post-Operative Management
- •Reported Outcomes
- •Patient Reporting Outcome Measures
- •Operative Time
- •Complications
- •References
- •12: Balloon Sinuplasty
- •Background
- •Reported Outcomes
- •Surgical Technique
- •Local Anesthesia Protocol
- •Procedure: Maxillary Sinus Balloon Dilation
- •Procedure: Frontal Sinus Balloon Dilation
- •Procedure: Sphenoid Sinus Balloon Dilation
- •References
- •Background
- •Surgical Technique
- •Nasal Polypectomy
- •Maxillary Sinus Disease
- •Ethmoid Sinus Disease
- •Frontal Sinus Disease
- •Sphenoid Sinus Disease
- •Mucocele Drainage
- •Balloon Sinus Dilation
- •Outcomes
- •References
- •Background
- •Patient Selection
- •Room Setup/Equipment
- •Navigation Systems
- •Monitoring
- •Patient Comfort
- •Staff Training
- •Reported Outcomes/Evolving Practice Patterns
- •References
- •16: Steroid Eluting-Implants
- •Background
- •Indications
- •Background
- •Surgical Technique (Video 15.1)
- •In-Office Polypectomy
- •Reported Outcomes
- •References
- •Surgical Technique
- •Reported Outcomes
- •References
- •Background
- •Cryotherapy
- •Radiofrequency Ablation
- •Surgical Technique
- •Reported Outcomes
- •References
- •18: Inferior Turbinate Reduction
- •Background
- •Extramucosal Surgical Techniques
- •Complete Turbinectomy
- •Laser Cautery
- •Electrocautery
- •Cryotherapy
- •Turbinate Lateralization
- •Submucosal Techniques
- •Microdebrider Turbinoplasty (Video 18.1)
- •Coblation (Video 18.2)
- •Radiofrequency Ablation (Video 18.3)
- •Ultrasound Turbinoplasty
- •References
- •Background
- •Surgical Technique
- •Bioabsorbable Nasal Sidewall Implant (LATERA)
- •Patient Selection
- •Local Anesthesia
- •Surgical Technique
- •Patient Selection
- •Local Anesthesia
- •Surgical Technique
- •References
- •Background
- •Topical Antibacterial Therapy
- •Topical Antifungal Therapy
- •Senior Author’s Practice
- •Conclusions
- •References
- •21: Intravenous Antimicrobial Therapy
- •Background
- •When Is Recalcitrant Chronic Rhinosinusitis Infectious?
- •Anatomically Complicated Infections
- •Empiric Oral Antimicrobial Therapy
- •Oral Versus Intravenous Therapy
- •Staphylococcus
- •Streptococcus
- •Enterococcus
- •Enterobacterales
- •Pseudomonas
- •Other Gram-Negative Organisms
- •Anaerobes
- •Multidrug-Resistant Organisms
- •Antimicrobial Stewardship
- •References
- •Background
- •Chronic Rhinosinusitis
- •Glucocorticoids
- •Intranasal Steroid Irrigations
- •Rationale
- •Evidence
- •The Exhalation Delivery System
- •Rationale
- •Evidence
- •Steroid-Eluting Sinus Stents
- •Rationale
- •Rationale
- •Glucocorticoid Insensitivity
- •Conclusions
- •References
- •Background
- •Pathophysiology
- •Diagnosis
- •Aspirin Challenge
- •Aspirin Challenge Procedure
- •Aspirin Desensitization
- •Preparation
- •Logistics
- •Monitoring
- •Protocols
- •Aspirin-Induced Reactions
- •Maintenance Aspirin Therapy after Desensitization
- •Silent Desensitization
- •References
- •Background
- •Conclusions
- •References
- •Background
- •Patient Selection
- •Dupilumab
- •Omalizumab
- •Mepolizumab
- •Summary
- •References
- •Background
- •Povidone-Iodine (PVP-I) Rinses
- •Manuka Honey Rinses
- •Colloidal Silver
- •Topical Antibiotics
- •Photodynamic Therapy
- •Phage Therapy
- •Sinonasal Microbiota Transfer (SNMT)
- •Conclusion
- •References
- •Index

Advances in Surgical and
Medical Interventions
forRecalcitrant Chronic
Rhinosinusitis
JivianneT.Lee
JakobL.Fischer
PeterH.Hwang
JosephK.Han
ScottP.Stringer
Editors
123

Advances in Surgical and Medical
Interventions for Recalcitrant Chronic
Rhinosinusitis

Jivianne T. Lee • Jakob L. Fischer
Peter H. Hwang • Joseph K. Han
Scott P. Stringer
Editors
Advances in Surgical
and Medical Interventions
for Recalcitrant Chronic
Rhinosinusitis

Editors
Jivianne T. Lee, M.D.
Division of Rhinology & Endoscopic
Sinus and Skull Base Surgery,
Department of Head & Neck Surgery
University of California Los Angeles David
Geffen School of Medicine
Los Angeles, CA, USA
Peter H. Hwang, M.D.
Division of Rhinology & Endoscopic
Skull Base Surgery, Department of
Otolaryngology-Head & Neck Surgery
Stanford University
Palo Alto, CA, USA
Scott P. Stringer, M.D.
Department of Otolaryngology-Head and
Neck Surgery
Virginia Commonwealth University School
of Medicine
Richmond, VA, USA
Jakob L. Fischer, M.D.
Department of Otolaryngology-Head &
Neck Surgery
San Antonio Uniformed Services Health
Education Consortium
San Antonio, TX, USA
Joseph K. Han, M.D.
Division of Rhinology & Endoscopic Sinus
and Skull Base Surgery
East Virginia Medical School
Norfolk, VA, USA
ISBN 978-3-031-89190-8 ISBN 978-3-031-89191-5 (eBook)
https://doi.org/10.1007/978-3-031-89191-5
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature
Switzerland AG 2025
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether
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claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
If disposing of this product, please recycle the paper.

Preface
In medical and surgical practice, we often encounter challenges that demand not
only our knowledge but also our relentless dedication to innovation and excellence.
Chronic rhinosinusitis, which remains an incompletely understood condition,
impacts millions of patients on a daily basis and serves as a substantial burden to
patients and healthcare providers alike. For those patients with recalcitrant chronic
rhinosinusitis, this burden is even more severe; and their optimal management
requires a thorough understanding of the broad spectrum of medical and surgical
treatment options available to alleviate symptoms and improve quality of life.
Through the collaborative efforts of experts worldwide, we have made signicant
strides in unraveling the mysteries of chronic rhinosinusitis. This textbook stands as
a culmination of those efforts, offering a synthesis of evidence-based practices,
innovative techniques, and nuanced strategies to optimize patient care.
In these pages, we offer a practical and comprehensive overview of the surgical
and medical approaches to management of recalcitrant chronic rhinosinusitis. From
foundational concepts to emerging algorithms, each chapter is designed to equip
clinicians and surgeons of any specialty who may treat chronic rhinosinusitis with
the most current knowledge to effectively address this complex condition. Narrated
videos accompany surgical chapters to demonstrate cutting-edge procedures for
treatment of refractory disease.
Interdisciplinary collaboration is emphasized throughout this textbook, recognizing the diverse expertise required for optimal patient care. We are honored to
present the most up-to-date surgical techniques and medical therapies from some of
the premier sinus surgeons, allergists, immunologists, and infectious disease specialists around the world.
We extend our gratitude to the contributors for their invaluable insights, and we
hope that this textbook serves as a valuable resource for those navigating the challenges of chronic rhinosinusitis.
Los Angeles, CA, USA JivianneT.Lee,M.D.
San Antonio, TX, USA JakobL.Fischer,M.D.
Palo Alto, CA, USA PeterH.Hwang,M.D.
Norfolk, VA, USA JosephK.Han,M.D.
Richmond, VA, USA ScottP.Stringer,M.D.
v

Contents
Part I Introduction
1 Introduction to Recalcitrant Chronic Rhinosinusitis . . . . . . . . . . . . . . 3
Alexander M. Choi and Tran B. Locke
Part II Surgical Procedures for Recalcitrant CRS
2 Revision Endoscopic Sinus Surgery: Maxillary, Ethmoid,
and Sphenoid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
John R. Craig
3 Mega-antrostomy/Endoscopic Medial Maxillectomy
for Recalcitrant Chronic Maxillary Rhinosinusitis . . . . . . . . . . . . . . . . 27
Noel Ayoub and Peter H. Hwang
4 Endoscopic Denker’s Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Justin P. McCormick and Jivianne T. Lee
5 The Reboot Procedure for Severe Chronic Rhinosinusitis
with Nasal Polyps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Claus Bachert, Zhang Nan, Philippe Gevaert, and Thibaut van Zele
6 Sphenoid Drill-out for Recalcitrant Chronic Sphenoid
Rhinosinusitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
William Derek Leight and Donald Arthur Leopold
7 Revision Sinus Surgery for Recalcitrant Chronic Frontal
Rhinosinusitis: Draf IIA/Draf IIB . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Amar Miglani and Devyani Lal
8 Modified Mini/Hemi/Subtotal/Central Lothrop for Recalcitrant
Chronic Frontal Sinusitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Michael S. Hegazin, Christina H. Fang, Prayag S. Patel, Jordon
G. Grube, and Jean Anderson Eloy
9 Draf III: Overall Concepts and the Mucosal Graft and Laterally
Based Flap Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Shilpa M. Rao and Bradford A. Woodworth
vii

viii
Contents
10 The Superior Lateral Anterior Pedicled Flap (SLAP) for the
Draf III Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Kazuhiro Omura and Nobuyoshi Otori
11 The Outside-in Draf III Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Peta-Lee Sacks, Kachorn Seresirikachorn, and Richard J. Harvey
Part III In-Ofce Procedures for Recalcitrant Chronic Sinusitis,
Chronic Rhinitis, and Chronic Nasal Obstruction
12 Balloon Sinuplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
Angela M. Donaldson
13 In-Office Endoscopic Sinus Surgery for Recalcitrant Chronic
Rhinosinusitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
Daniel B. Spielman and John M. DelGaudio
14 In-Office Navigation for Recalcitrant Chronic Rhinosinusitis . . . . . . . 147
Nora W. Perkins
15 In Office Polypectomy for Recalcitrant Chronic Sinusitis with
Polyposis (CRSwNP) Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Bader M. Alim, Juan Carlos Hernaiz-Leonardo, and Amin R. Javer
16 Steroid Eluting-Implants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
Firas Sbeih, Jonathan Tyes, and Troy Woodard
17 Cryoablation and Radiofrequency Ablation of Posterior
Nasal Nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
Neil N. Patel and Patricia A. Loftus
18 Inferior Turbinate Reduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
Stephen Leong, Michelle Yu, and Ashutosh Kacker
19 Radiofrequency and Bioabsorbable Nasal Implantation for
Treatment of Nasal Valve Obstruction . . . . . . . . . . . . . . . . . . . . . . . . . . 193
Greg E. Davis and Craig Miller
Part IV Medical Interventions for Recalcitrant Chronic Rhinosinusitis
20 Topical Antibiotics in Treatment of Recalcitrant Chronic
Rhinosinusitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
Keonho Albert Kong and Scott P. Stringer
21 Intravenous Antimicrobial Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
Amy V. Dora and Matthew Bidwell Goetz
22 Topical Corticosteroid Therapy in Recalcitrant Chronic
Rhinosinusitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
Daniel R. Romano, Daniel P. Lander, and John S. Schneider

Contents
23 Aspirin Desensitization for Recalcitrant Chronic Rhinosinusitis
with Nasal Polyposis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269
Anthony F. LaCava and John V. Bosso
24 Leukotriene Modifiers for Recalcitrant Chronic Rhinosinusitis . . . . . 291
Akaansha Ganju, Vivian Wang, and Joseph Yusin
25 Biological Treatment for Chronic Rhinosinusitis with
Nasal Polyposis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303
Joseph K. Han and Dafna Gershnabel Milk
26 Novel Therapies for Recalcitrant Chronic Rhinosinusitis . . . . . . . . . . . 321
Juan Carlos Hernaiz-Leonardo, Bader M. Alim, and Amin R. Javer
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 337
ix

Contributors
BaderM.Alim,M.D. Department of Otolaryngology—Head and Neck Surgery,
Prince Mohammed Bin Abdul Aziz Hospital, National Guard Health Affairs,
Medina, Saudi Arabia
Noel Ayoub, M.D. Division of Rhinology & Endoscopic Skull Base Surgery,
Department of Otolaryngology-Head & Neck Surgery, Stanford University School
of Medicine, Stanford, CA, USA
Claus Bachert, M.D., Ph.D. Department of Oto-Rhino-Laryngology, Münster
University, Münster, Germany
First Afliated Hospital, Sun Yat-sen University, International Airway Research
Center, Guangzhou, China
Upper Airways Research Laboratory, Department of Oto-Rhino-Laryngology,
Head and Skin, Ghent University, Ghent, Belgium
John V. Bosso, M.D. Division of Rhinology, Department of Otolaryngology,
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
Alexander M. Choi, M.D. Department of Otolaryngology—Head and Neck
Surgery, Baylor College of Medicine, Houston, TX, USA
John R. Craig, M.D.
Henry Ford Health, Detroit, MI, USA
Greg E. Davis, M.D.
Puyallup, WA, USA
John M.DelGaudio, M.D. Department of Otolaryngology, Emory University,
Atlanta, GA, USA
Angela M. Donaldson, M.D. Department of Otolaryngology Head and Neck
Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
Amy V. Dora, M.D. Infectious Diseases, VA Greater Los Angeles Healthcare
System, Los Angeles, CA, USA
Jean Anderson Eloy, M.D. Department of Otolaryngology—Head and Neck
Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
Department of Otolaryngology-Head and Neck Surgery,
Otolaryngology, Proliance Surgeons, Seattle and
xi

xii
Contributors
Department of Otolaryngology—Facial Plastic Surgery, Cooperman Barnabas
Medical Center, Robert Wood Johnson Barnabas Health, Livingston, NJ, USA
Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey,
Rutgers New Jersey Medical School, Newark, NJ, USA
Department of Neurological Surgery, Rutgers New Jersey Medical School,
Newark, NJ, USA
Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical
School, Newark, NJ, USA
ChristinaH.Fang,M.D. Department of Otorhinolaryngology—Head and Neck
Surgery, Monteore Medical Center, The University Hospital of Albert Einstein
College of Medicine, Bronx, NY, USA
AkaanshaGanju,M.D. Department of Allergy and Immunology, Veterans Affairs
Greater Los Angeles Healthcare System, Los Angeles, CA, USA
Philippe Gevaert, M.D. Department of Oto-Rhino-Laryngology, Münster
University, Münster, Germany
Upper Airways Research Laboratory, Department of Oto-Rhino-Laryngology,
Head and Skin, Ghent University, Ghent, Belgium
Matthew Bidwell Goetz, M.D. Infectious Diseases, VA Greater Los Angeles
Healthcare System, Los Angeles, CA, USA
Clinical Medicine, David Geffen School of Medicine at UCLA,
Los Angeles, CA, USA
Jordon G. Grube, D.O. Department of Otolaryngology—Albany Medical
College, Albany Medical Center, Albany, NY, USA
Joseph K. Han, M.D., F.A.R.S., F.A.A.A.A.I. Division of Rhinology &
Endoscopic Sinus and Skull Base Surgery, East Virginia Medical School,
Norfolk, VA, USA
RichardJ.Harvey,M.D., Ph.D. Rhinology and Skull Base, Applied Medical
Research Centre, St Vincent’s Hospital, Darlinghurst, NSW, Australia
Department of Otolaryngology, UNSW and Macquarie University, Sydney,
NSW, Australia
Michael S. Hegazin, D.O. Department of Otolaryngology—Head and Neck
Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
Juan Carlos Hernaiz-Leonardo, M.D. Department of Otolaryngology—Head
and Neck Surgery, University of British Columbia, Vancouver, BC, Canada
PeterH.Hwang,M.D., F.A.C.S., F.A.R.S. Division of Rhinology & Endoscopic
Skull Base Surgery, Department of Otolaryngology-Head & Neck Surgery,
Stanford University School of Medicine, Stanford, CA, USA
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