The Benefit of Middle Turbinate Stabilization during Functional Endoscopic Sinus Surgery, A Comparative Study

Abstract

Background: The laterlization of middle turbinate and adhesion to the lateral nasal wall is a common coplication of fuctional endoscopic sinus surgery (FEESS) result in failure of initial procedure and obstruction of osteomeatal complex. Current procedure for middle turbinate medialization, include creation of controlled synaechia between middle turbinate and nasal septum (bolgerization) and fixation of middle turbinate to nasal septum by suturing using absorbale vicryl suture (conchopexy). Objective: Is to compare between FESS with middle turbinate fixation to the septum by conchopexy or bolgerization technique to prevent laterlization of middle turbinate and thier impact on postoperative symptoms and signs and conventional FESS without fixation of the middle turbinate to the septum. Patients and Methods: The current stydy include 80 patients, they were divided into 3 groups, Group 1, include 30 patients underwent conventional FESS with medialization of middle turbinate only, using middle meatal pack, lest for 2 days. Group2, included 25 patients underwent FESS with Bolgerization method. Group3, included 25 patients underwent FESS with conchopexy by suturing the middle turbinate to the septum. Preoperative, postoperative, symptoms and endoscopy findings were compare among all the 3 groups. Result: Significant improvement is achieved in all groups and this improvement was founds to be significant stastically for nasa obstruction, nasal discharge, olfactory function, (P > 0.001)and for facial pain (P = 0.009). Bolgerization technique had better result in improving olfactory disturbance as compared to other methods. The pstoerative endoscopic findings improvement score was stastically significant for all groups with (P = 0.002) for the 1st group and (P = 0.001) fore the 2nd and 3rd groups. Regarding synaechia and laterlization of middle turbinate, in group 3 one of the patient had laterlization and synaechia between the middle turbinate and the lateral nasal wall (4%), 4 patients in group 2 (16%), and 10 patients in group 1 (33.3%). Conclusion: Conchopexy and Bolgerization are effective method to stabilize middle turbinate and preventing middle turbinate laterlization and synaechia following FESS with highly significant improvement of postoperative symptoms and endoscopic findings.