Abstract
Background Middle turbinate (MT) lateralisation with adhesion formation (MiTLAF) is a common complication following endoscopic sinus surgery, frequently resulting in surgical failure, persistence of preoperative symptoms, and delayed secondary complications. Packing materials, splints, or spacers reduce the risk of MiTLAF but often result in postoperative nasal obstruction and discomfort, along with reduced access for irrigation. Temporary suture medialisation of the MTs reduces the risk of MiTLAF and prevents the problems encountered with packing, splints, or spacers. However, the techniques described in the literature are technically challenging and often ineffectual. Methods We describe a method of suture placement that provides a secure temporary MT medialisation, without the technical challenges of traditional techniques, using a 4-0 Monocryl (Poliglecaprone 25, Ethicon, Somerville, NJ, USA) suture on a 19 mm precision point reverse cutting PS-2 curved needle. We review 25 consecutive patients undergoing sinonasal procedures with our new technique and assess for MiTLAF. Results In our cohort, only one patient experienced MiTLAF which was not clinically significant. Conclusions Our method is simple, easy to perform, and highly effective and prevents adhesion formation without the need for postoperative splints or packing.
Highlights
Middle turbinate (MT) lateralisation with adhesion formation (MiTLAF) is a common complication following endoscopic sinus surgery, frequently resulting in surgical failure, persistence of preoperative symptoms, and delayed secondary complications
Factors likely to increase the risk of MiTLAF include the presence of matched mucosal abrasions on the lateral surface of the middle turbinate (MT) and the lateral nasal wall, mucosal abrasions at the axillary region of the MT, resulting in lateralising contractile forces during wound healing, MT destabilisation secondary to posterior ethmoidectomy or sphenoid access procedures, and postoperative blood clot formation [4, 5]
The placement of packing materials, splints, or spacers between the MT and lateral nasal wall results in postoperative nasal obstruction and discomfort whilst the pack is in situ [8]
Summary
Middle turbinate (MT) lateralisation with adhesion formation (MiTLAF) is a common complication following endoscopic sinus surgery, frequently resulting in surgical failure, persistence of preoperative symptoms, and delayed secondary complications. Splints, or spacers reduce the risk of MiTLAF but often result in postoperative nasal obstruction and discomfort, along with reduced access for irrigation. Factors likely to increase the risk of MiTLAF include the presence of matched mucosal abrasions on the lateral surface of the middle turbinate (MT) and the lateral nasal wall, mucosal abrasions at the axillary region of the MT, resulting in lateralising contractile forces during wound healing, MT destabilisation secondary to posterior ethmoidectomy or sphenoid access procedures, and postoperative blood clot formation [4, 5]. Packs made from absorbable materials prevent the pain of removal associated with nonabsorbable packs Whilst present, they contribute to patient discomfort and limit the use of postoperative irrigation and topical medications. Certain absorbable materials have been shown to increase the risk of adhesion formation [3, 10]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
