• Revision sphenoid sinus surgery is usually most easily performed after a complete ethmoidectomy.
• The sphenoid sinus natural ostium can typically be found using the superior turbinate as a landmark, even in revision cases.
• Once a decision is made to enlarge the sphenoid sinus ostium, a maximally wide opening will minimize the risk of stenosis.
• Attempts at widening the natural ostium inferiorly and medially do not typically improve the chances of a patent ostium
postoperatively and can lead to bleeding and unnecessary mucosal disruption.