Part 2 book “Office-Based rhinology: Principles and techniques” has contents: In-Office treatment of post-endoscopic sinus surgery issues, office-based management of mucoceles, nasal fractures - closed reduction in the office setting, office-based nasal polypectomy, office-based evaluation and treatment of epiphora, and other contents. | Chapter 8 In-Office Treatment of Post-Endoscopic Sinus Surgery Issues Robert T. Adelson James N. Palmer Introduction Endoscopic sinus surgery (ESS) that preserves native anatomy and sinonasal mucosa to the greatest degree possible has become the universally accepted surgical modality by which chronic rhinosinusitis (CRS) is addressed. Inherent to this operation is the understanding, by both patient and surgeon, that operative procedures are adjunctive to the medical management of an underlying inflammatory disorder. Similarly, the postoperative care of patients undergoing ESS remains akin to a moving target. The idealized postoperative sinus cavity can only be achieved by active participation in medical management and office-based minor surgical procedures. Medical management includes both topical and oral route corticosteroids and antibiotics whereas surgical procedures are focused on the removal of material that may predispose to either cicatricial occlusion of sinus ostia or re-infection of a paranasal sinus. Our postoperative procedures are aligned with the current concept of functional ESS that emphasizes not just improving the patency of sinus ostia to facilitate the egress of mucus, but, more importantly, to enhance the penetration of medicated topical irrigations. Although ESS is the widely established standard of care for the surgical management of CRS, its postoperative management is less well characterized. There are wide variances between surgeons with regard to both medical and surgical therapy. Common to all is the understanding that the inflammatory nature of CRS requires long-term follow-up and occasional medical or surgical interventions to control the underlying disease process. In the absence of blinded, prospective, diseasematched, controlled studies with validated outcome measures at long-term follow-up, there is no substantial evidence to guide postoperative Our routine postoperative care involves a regimen of weekly .
