Management of the middle turbinate during functional endoscopic sinus surgery

Abstract

Controversy continues to surround the topic of middle turbinate resection (MTR) during endoscopic sinus surgery. Proponents of MTR cite lower incidences of synechiae formation and lateralization of the middle turbinate, as well as improved intraoperative and postoperative access to the middle meatus. Potential complications, such as alterations of nasal function, atrophic rhinitis, hyposmia, and secondary frontal sinusitis caused by MTR, have been addressed in the recent literature. Yet, despite the proven safety of this procedure, routine MTR is not advocated by most sinus surgeons. Our approach has been to perform partial MTR in cases of a diseased, destabilized, or obstructing middle turbinate. More recently, we have employed a technique for medialization of the middle turbinate or middle turbinate remnant using an absorbable transseptal suture. The stitch is placed through both middle turbinates and the nasal septum, holding the turbinates in a medial position. We have used this procedure in 75 patients undergoing endoscopic sinus surgery at New York University Medical Center between July 1998 and July 2000. There have been no complications associated with placement of the suture and no cases of middle turbinate lateralization or significant synechiae formation. This technique represents an alternative to MTR in the management of the middle turbinate during endoscopic sinus surgery and may also be used to prevent lateralization of a middle turbinate remnant in cases of partial MTR.