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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
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 the whole or part of the material is concerned, specically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microlms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specic statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional afliations.
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 signicant 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 JivianneT.Lee,M.D. San Antonio, TX, USA JakobL.Fischer,M.D. Palo Alto, CA, USA PeterH.Hwang,M.D. Norfolk, VA, USA JosephK.Han,M.D. Richmond, VA, USA ScottP.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-Ofce 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

BaderM.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 Afliated 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
ChristinaH.Fang,M.D. Department of Otorhinolaryngology—Head and Neck
Surgery, Monteore Medical Center, The University Hospital of Albert Einstein College of Medicine, Bronx, NY, USA
AkaanshaGanju,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
RichardJ.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 PeterH.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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