Revision Endoscopic Sinus Surgery for Maxillary Recirculation

Chronic sinusitis is, as the name implies, a chronic disease.  There is no permanent cure for chronic sinusitis, but there are many treatments that can improve patients’ symptoms. The first step in treatment of chronic sinusitis is using a topical nasal steroid, like Flonase (now over the counter) and a saline rinses.  If patients continue to have symptoms despite medical therapy, and they have an abnormal sinus CT (available in our office) then endoscopic sinus surgery is an option.  Unfortunately patients may require more than one operation.  A large part of my practice is revision sinus surgery.  This can be due to polyp regrowth with symptom recurrence or due to scar tissue or incomplete prior surgery.

A unique indication for revision endoscopic sinus surgery is maxillary recirculation.  This occurs when the natural ostium (hole) of the maxillary (cheek) sinus is not connected to the surgical opening that was made at the previous sinus surgery.  The cilia in the sinus beats the mucus out of the natural ostium, and it falls back into the surgical opening in the maxillary.  Then it goes around and around from maxillary sinus to the nasal cavity.  Eventually it falls out into the nasal cavity, and patients describe usually unilateral thick post nasal drainage.  It can be a source of recurrent infections as well, since bacteria frequently infect the thick mucus that resides in the maxillary.  Nasal steroids and rinses can decrease symptoms, however definitive repair requires revision surgery.

By connecting the two openings in the maxillary sinus the recirculation ceases.  I have had many patients that had decades of “allergies” resolve after the revision surgery.  Convincing patients that had previous endoscopic sinus surgery in the 1980s or 90s is challenging, but fortunately the techniques have improved that do not require packing anymore.  Without packing there is minimal pain.

If you had endoscopic sinus surgery in the past and you have symptoms similar to those list above, please make an appointment; with a few diagnostic tests I can ascertain if your would benefit from revision surgery.

I encourage you to visit  where dozens of patients have described their experiences after revision endoscopic sinus surgery for chronic sinusitis.


Josh Meier, M.D. F.A.R.S.

Director Reno Tahoe Sinus Center