Effect of middle turbinate intervention on outcomes of middle meatal endoscopic surgery

Abstract

Background and objective Middle turbinate position, bulk, and shape play a significant role in the determination of drainage and ventilation at the middle meatus. The middle turbinate constitutes the corner stone for the performance of drainage as well as ventilation functions at the area of the ostiomeatal complex. As one of the major aims of middle meatal endoscopic surgery is providing sufficient drainage and ventilation at the level of this complex, the middle turbinate should be assessed properly before the surgery with regard to its position, size, and shape, which may predispose for sinusitis through the obliteration of the ostiomeatal complex as in cases of paradoxical middle turbinate, concha bullosa of the middle turbinate, hypertrophy of the middle turbinate, and double middle turbinate. These varieties of abnormal middle turbinate need to be interfered accordingly to reduce the risk for recurrence of sinusitis after the surgery. In addition, the normal middle turbinate may lateralize postoperatively and subsequently result in the reobstruction of the drainage and ventilation at the middle meatal area. Therefore, for the purpose of maintenance of sufficient drainage and ventilation after middle meatal endoscopic surgery, it is suggested to interfere with the normal middle turbinate either by means of its partial resection at its lower part, its medialization and further fixation of it to the nasal septum with a stitch, or by creating a synechia with the mucoperiosteal flap over the nasal septum. For this reason the serial analytic coherent clinical study was planned prospectively to postulate as to which technique is the best among the previously mentioned three techniques and compared further with noninterfered middle turbinate cases. Patients and methods Sixty patients between 14 and 63 years of age with chronic sinusitis presented with clinical as well as radiological evidence of maxilloethmoidal sinusitis with or without frontal and sphenoidal involvement at ENT OPD, Al-Tarahom Private Center (Elbyda, Libya), during the period between July 2013 and March 2015 and underwent functional endoscopic sinus surgery. The patients were divided into four groups, group A ( n = 16), group B ( n = 18), group C ( n = 6), and group D ( n = 20), which included those patients who proceeded after middle meatal endoscopic surgery with the medialization of the ipsilateral middle turbinate and creation of a synechia between it and the nasal septum, partial resection of the ipsilateral middle turbinate at its lower third, medialization and further fixation of the ipsilateral middle turbinate to corresponding nasal septal flap using a vicryl stitch material, or just medialization of the ipsilateral middle turbinate without any further fixations, respectively. The four groups were compared in relation to postoperative patency persistence of the ipsilateral middle meatus and correlated with the incidence of sinusitis recurrence after the surgery. Results and conclusion An overall 49% of the patients who underwent just medialization of the ipsilateral middle turbinate without any further fixations developed recurrence of sinusitis due to reobliteration of the middle meatus either by means of a synechia between the middle turbinate and the lateral wall or by means of extreme lateralization of the middle turbinate compared with the other groups. All patients in other groups achieved complete improvement without any evidence of recurrence of sinusitis after 1 year of follow-up, apart from 12% of patients in group B who presented with evidence of sinusitis recurrence after 3–6 months postoperatively. Broadly speaking, the intervention with the normal middle turbinate can be considered as one of the important steps during the middle meatal endoscopic surgery that may help significantly toward the improvement of outcomes of this commonly performed procedure.