Is image guided sinus surgery a standard recommendation for ethmoid mucocele for someone who's had previous rhinoplasty?

Depends: For a first sinus surgery image guidance not necessary unless your surgeon feels that severe anatomic distortion exists or mucocele impinging on important structures. Since mucocele is expansive then it has done most of the work and it is usually easy to open and drain it for an experienced sinus surgeon. Ask how many surgeon has done or get second opinion.

Yes: Image guided surgery is the safest and most accurate way to perform surgery.

No: Image guidance can be helpful though, particularly if the mucocele is in the superior or posterior ethmoid, or there has been previous sinus surgery. Rhinoplasty history should not be a factor.

Yes: Image guided sinus surgery helps to better define anatomy during surgery in more complex sinus cases. Ethmoid mucocele after prior rhinoplasty certainly qualifies.