Partial Middle Turbinate Resection Research Articles

Partial Resection versus Preservation of Middle Turbinate in Surgery for Chronic Rhinosinusitis With - Without Nasal Polyposis

Partial Resection versus Preservation of Middle Turbinate in Surgery for Chronic Rhinosinusitis With - Without Nasal Polyposis

Preventive Measures of Middle Turbinate Lateralization After Endoscopic Sinus Surgery: An Updated Review.

Introduction: The middle turbinate (MT) is the most important anatomical structure inside the nasal cavity and a landmark in the identification of skull base, ethmoid cells, and lamina papyracea. Postoperatively, lateralizationof the MT can cause synechia and obstruction of the middle meatus and the maxillary, ethmoid, or frontal sinuses.Objective: To review the current literature about the outcome of different techniques used intraoperatively to prevent lateralization of MT after functional endoscopic sinus surgery (FESS).Materials and methods: This retrospective narrative literature review provides a summary of current and past research publications about different techniques used intraoperatively to prevent MT lateralization after FESS.Results: Many methods have been described to prevent the lateralization of MT and synechiae formation. These methods include controlled synechiae, suture lateralization, metal clips, partial resection of MT, middle meatus implants, and steroid-eluting implants and stents.Conclusion: The ideal FESS should include preservation of the MT, reducing its lateralization, and preventing synechia formation.Different techniques have been discovered in an attempt to prevent this complication.

The impact of bolgerization versus partial resection of the middle turbinate on frontal sinusotomy patency outcome: A randomised controlled study.

This study aimed to compare the effects of middle turbinate resection vs bolgerization on the incidence of middle meatus synechia and their prognostic value on the patency outcomes after frontal sinusotomy. A randomised controlled study. Tertiary centre hospital. Thirty-eight patients undergoing bilateral frontal sinusotomy for chronic frontal sinusitis were included. Partial middle turbinate resection was alternated with bolgerization in both nasal cavities of every patient. The Lund-Kennedy endoscopic scores (LKESs) for both sides were compared at the first, third and sixth months postoperatively. Middle meatus synechia was assessed using the visual analogue score (VAS). Sinus patency was assessed at the end of the sixth month using a 70° nasal endoscope. The sinus patency outcome was significantly higher in the resected group (34\38) than the bolgerized group (26\38), (P=.047*). The VAS scores suggested that the middle turbinate bolgerization group showed a significantly higher incidence of middle meatal synechia than the partial middle turbinate resection group (4.47±2.617 vs 3.29±2.301; P=.040*). Middle turbinate resection showed more favourable results than bolgerization concerning the sinus patency outcome after frontal sinusotomy. It also showed a lower incidence of middle meatus synechia postoperatively.

Comparison between the endoscopic scores of bolgerization versus partial resection of the middle turbinate for management of the postoperative lateralization in the early follow-up period after endoscopic frontal sinusotomy: A randomized controlled study

BackgroundFrontal sinusotomy is a challenging procedure that needs meticulous handling due to its unique anatomical position. Postoperative middle turbinate lateralization is critical comorbidity for the success rate, and many techniques are adopted to prevent it. The study aimed to compare the effect of middle turbinate bolgerization and partial resection on the postoperative endoscopic scores and assess their impact on the middle meatus and the frontal recess outcome. Patient and methodsThis prospective study was conducted on forty-one patients undergoing bilateral frontal sinusotomy for chronic frontal sinusitis. Nasal cavities were randomized so that partial middle turbinate resection technique was done alternately with bolgerization approach in every patient. Each participant acted as their control. Both sides were compared using Lund Kennedy Endoscopic Score (LKES) and Perioperative Sinus Endoscopy Score (POSE) at the baseline, 1st, 3rd, and 12th-month intervals postoperatively. Also, middle turbinate status was assessed at the end of the 12th-month interval using POSE score. ResultsThe total frontal sinus patency rate was 82.9% (63/76 operated sinus). Baseline scores, LKES (3.79 ± 0.777 vs 4.05 ± 0.769, p = 0.142, for the side of resection and the side for bolgerization respectively) and POSE (1.79 ± 0.413 vs 1.82 ± 0.393, p = 0.777, for the side of resection and the side for bolgerization respectively). Regarding LKES, the differences between both operated sides were fluctuating with p values: 0.001*, 0.171, and 0.044* for the 1st, 3rd, and 12th months follow-up intervals, respectively. Regarding the POSE score of the frontal sinus, the difference between both groups was steadily increasing with p values: 0.318, 0.119, and 0.017* for the 1st, 3rd, and 12th months follow-up intervals. The middle turbinate's POSE score at the 12th month was significantly higher in the side allocated for bolgerization (p-value = 0.008*). ConclusionPartial middle turbinate resection showed favorable endoscopic outcomes than bolgerization at the 12th month follow up period in patients undergoing primary ESS for chronic frontal sinusitis.

Functional Endoscopic Sinus Surgery of Nasal Polyposis: The Vexing Question of Whether to Resect or Preserve Middle Turbinate.

Functional endoscopic sinus surgery is the mainstay of surgical management of nasal polyposis since 1975. The decision between the partial resection and preservation of the middle turbinate (MT) has stirred up considerable debate. Partial MTR permits easy access to the affected paranasal sinuses intraoperatively and postoperatively. However, there may be alteration of nasal function, frontal sinusitis and anosmia. Preservation of middle turbinate is precludes these complications, and allows the MT to serve as a vital anatomical landmark for revision surgery. Therefore, our study compared the outcomes of the two approaches to aid surgeons in deciding the best possible approach. Randomized control trial. 31 patients (60 sides of nasal cavity) with nasal polyposis were divided into two groups. Group I consisted of 30 sides of nasal cavity with middle turbinate resection, while group II consisted of 30 sides of nasal cavity without middle turbinate resection. Both the groups were compared postoperatively for 6months. In group I and group II, 5 sides (16.6%) and 11 sides (36.6%) showed polypoidal changes respectively. 3 sides (10%) in group I and 8 sides (26.6%) in group II showed blockage of maxillary sinus ostia. All the sides in group I had patency of frontal sinus. In group II, 5 sides (16.6%) showed blockage of frontal sinus ostia. The maxillary antrostomy patency in group I and group II were 90% (27) and 73.33% (22) respectively. Assessment of symptomatic improvements for nasal obstruction, hyposmia, headache and rhinorrhoea was done using questionnaires. Symptomatic improvement was higher in group I compared to group II with statistical significance (p = 0.001). Our study demonstrated that partial resection of middle turbinate decreased the chances of recurrence of disease and post-operative complications and resulted in significantly better symptomatic improvements.

Partial resection of the middle turbinate during endoscopic sinus surgery for chronic rhinosinusitis does not lead to an increased risk of empty nose syndrome: a cohort study of a tertiary practice.

The treatment of the middle turbinate (MT) during endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) remains a contentious issue with arguments both for and against its resection. The purpose of this study was to examine the clinical impact of partial MT resection (PMTR) during ESS, paying particular attention to the risk of developing empty nose syndrome (ENS) and alteration to olfaction. This cohort study was performed on prospectively collected data. A total of 177 patients underwent ESS for CRS; 93 had PMTR and 84 MT preservation (MTP). Preoperative data collection included subjective symptom scores as per the Adelaide Disease Severity Score (ADSS), Lund-Mackay scores, and nasal polyp status. The Empty Nose Syndrome 6-Item Questionnaire (ENS6Q) was administered by telephone consultation and analyzed alongside postoperative symptom scores. There was no difference in ENS6Q scores in patients who underwent PMTR vs those who had MTP. Patients who underwent PMTR had a higher baseline disease on Lund-Mackay scoring, and were more likely to be nasal polyp patients and be undergoing revision surgery. ADSS scores demonstrated significant improvements in all rhinologic symptoms, with no difference between the cohorts. PMTR is an adjunctive procedure to ESS. This study has established that PMTR as performed by the senior author carries no additional risk of developing ENS symptoms as defined by the ENS6Q, and that it carries no additional risk to olfaction or other rhinologic symptoms. PMTR can be safely considered at time of ESS, especially in patients at risk of lateralization of the MT.

Evaluation of the effect of partial middle turbinate resection on the olfactory function

Evaluation of the effect of partial middle turbinate resection on the olfactory function

The effect of middle turbinate resection on topical drug distribution into the paranasal sinuses.

During sinus surgery, partial or complete resection of the middle turbinate (MT) is sometimes necessary because of polypoid changes or demineralization. Topical drug delivery to the paranasal sinuses is an integral component in managing chronic rhinosinusitis (CRS) with and without nasal polyposis. The purpose of this study was to examine the role of the MT and MT resection in topical drug distribution into the sinuses via nebulization. We report on a novel technique of quantitatively evaluating the delivery of nebulized dye in cadavers. Endoscopic sinus surgery was performed on 5 fresh cadavers. Complementary colored dyes mixed with saline were successively nebulized using the following protocol: (1) fluorescein prior to MT resection; (2) brilliant green following partial MT resection; and (3) methylene blue following total MT resection. Photodocumentation of the sinuses was performed following each nebulization and standardized photoanalysis was performed. Successive nebulizations with fluorescein, brilliant green, and methylene blue produced a complementary staining pattern that provided an easy side-by-side analysis of the extent of mucosal staining. Dye delivery to the frontal and sphenoid sinuses significantly increased following partial resection of the MT (p = 0.013 and p = 0.0027, respectively) and complete resection of the MT (p = 0.027 and p = 0.027, respectively). Following complete MTR, dye delivery to the maxillary sinus significantly increased compared to baseline (MT intact) (p = 0.0027). Resection of the MT appears to have a significant effect on nebulized drug delivery into the frontal, maxillary, and sphenoid sinuses. Future prospective studies will help delineate the clinical relevance of this effect.

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

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.

A Randomized Control Trial of Partial Middle Turbinate Resection in Functional Endoscopic Sinus Surgery

A Randomized Control Trial of Partial Middle Turbinate Resection in Functional Endoscopic Sinus Surgery

English

INTRODUCTION: Middle turbinate is a dynamic structure which is in a crucial position that plays a significant role in pathogenesis of rhinosinusitis and headache. The goal of treating sinus disease with surgery has evolved from removing all diseased sinus mucosa to specific exenteration of the tissue causing obstruction. Once ventilation is restored, it is postulated that the mucosa may regain near normal appearance and function. This study was conducted to evaluate and observe the benefits following partial middle turbinate resection during FESS on various symptoms of rhino sinusitis. METHODOLOGY: This is a random control trial. All the patients with chronic rhino sinusitis, was selected, studied, and subjected for FESS with partial middle turbinate resection for 50 patients and 50 patients subjected for FESS with middle turbinate preservation. All the patients were observed in post operative follow up for five months and the data was subjected for statistical analysis. RESULTS: In our study there was strongly significant p value of 0.000, 0.002, and 0.000 for edema, discharge and synechiae respectively and moderately significant p value of 0.047 for crusts with respect to DNE findings. In the patients with partial middle turbinate resection, the post operative DNE results also show improvement of 80% in edema, 40% in discharge, 40% in scarring, 30% in synechiae and 20% in crusts compared to the patients with preserved middle turbinate. CONCLUSION: Partial Middle turbinectomy appears to be a positive variable and an adjuvant technique in patients with inflammatory disease of paranasal sinus, in terms of the improvement and maintenance of ventilation of osteomeatal complex, especially if anatomical anomalies present. Partial middle turbinectomy is recommended whenever exposure is compromised.

Role of nasal middle turbinectomy in nasal headache

Objective: To analyse the results of total resection of middle turbinate and partial resection of middle turbinate on nasal headache Design: Prospective study of chronic rhinogenic headache in 40 patients between January 2011 and December 2011, 25females and 15males,their age range was 18-55years,with a mean age of 32.4 years and their range of duration of headache was 1-20 years, with a mean duration of headache 6.125 years.The operation of total resection of middle turbinate has been performed in 40 ethmoidectomies & a control group of partial resection of middle turbinate has been performed by the same author in 40 ethmoidectomies. All the patients underwent pre-operative & post-operative assessment with a questionnaire of headache, using the visual analogue scale (VAS). Results: Total resection of middle turbinate showed complete cure of headache in 40 ethmoidectomies (100 percent) by questionnaire (subjective analysis). A control group of partial resection of middle turbinate showed complete cure in 20 ethmoidectomies (50 percent ), improvement (by 70%) in 4 ethmoidectomies (10 percent) & unchanged or worsened headache in 16 ethmoidectomies (40 percent) by subjective analysis at the last follow- up.The difference was statistically highly significant(P<0.01). Conclusion: Total resection of nasal middle turbinate in ESS is a good choice in chronic rhinogenic headache, not responding to usual medical anti-headache treatment & not septic. I. Introduction Each patient completed a questionnaire to elicit information on medications, medical history and the patient's subjective assessment of pre-operative & post-operative rhinogenic headache using standarized symptoms questionnaire quality of life score by Lund and Macky, the visual analogue scale (VAS). The scoring is range from 0 to 10 in which 0 represents no symptom & 10 represents greatest severity . 1 Local anesthetic test is done during the attack of headache. The nose is decongested then a piece of cotton soaked in xylocaine 2%, adrenaline 1:200.000 is put in the nose at any suspected contact area in the nose. The cotton is left for 5 minutes. Positive test is considered if the patient shows improvement of headache severity more than 50%. The simple presence of an intranasal pathology does not prove its role in headache causation.The etiologic role of this pathology should be confirmed by diagnostic local anesthetic testing as the source of pain. 2 The appropriate management of the middle turbinate remains controversial and arguments for its resection and for its preservation have been proposed. 3-5 Davis et al. reported that middle turbinectomy was the most important variable in predicting patency of the middle meatus antrostomy .6 A standard ESS Technique is done, the uncinate process is incised and removed & the middle turbinate is medialized with a freer elevator, the ethmoid bulla is entered & removed. A posterior ethmoidectomy is performed. The frontal sinus ostium is identified with a blunt curved suction .The natural ostium of the maxillary sinus is identified .The sphenoid sinus is entered medially and inferiorly as indicated. At this point, the procedure is essentially completed except for planning in regard to prevention of post-operative complications . 7 the present author has performed these procedures, as previously described, 7 on 40 patients with chronic rhinogenic headache. At a mean follow-up of 6 months. The patients were seen in the office 1 week post-operatively, any crusts are suctioned from the middle meatus & ethmoid, saline nasal irrigations were administrated. All the patients were followed up by endoscope and questionnaire of headache. The aim of this report was to review the cases of total resection of middle turbinate performed on nasal headache and compare the results with those of partial resection of middle turbinate performed by the same author at the same institution & period.

Endonasal procedures in endocanalicular dacryocystorhinostomy

Dear Editor, First of all, thank you for your critiques and valuable comments. Diode laser, as being one of the most portable and least expensive of the lasers available for endocanalicular dacryocystorhinostomy (ECL DCR), is the most commonly used laser for ECL DCR [1–3]. It can ablate bone and the soft tissues without causing excessive collateral damage [3]. We have been also performing diode laser ECL DCR, since the beginning of 2006 [4, 5]. Initially, our surgical procedure was simply the application of the laser energy until the probe was visualized by nasal endoscopy, and then the enlargement of the neo-ostium by additional laser applications [4]. During the follow-up of those initial cases, we recognized that synechia between the lateral surface of the middle turbinate (MT) and the medial surface of the lateral wall of the nose was a common finding in the failures [4]. We conducted a retrospective study comparing those two groups of patients who underwent diode laser ECL DCR with and without endonasal procedures [4]. There were three differences between the surgical procedures of two groups: (1) initial partial anterior inferior third middle turbinate resection (MTR) before laser application, (2) endonasal enlargement of the neo-ostium, after obtaining the initial fistula by laser application, and (3) antibioticsoaked cotton pledget packed in the sac at the end. The anatomical success rates increased from 71% to 93% by adding the endonasal procedures. The synechia between the MT and the lateral nasal wall was the most common finding in the failures encountered in cases without endonasal procedures. Routine MTR is a controversial procedure. Some favor MT preservation, while some practice MTR routinely [6]. However, none of the surgeons provided any scientific rationale for their approaches [6, 7]. Partial MTR was reported to be a safe procedure without any adverse effect on nasal physiology [6]. There has been considerable debate as to whether the ostium size made during dacryocystorhinostomy plays a role on the outcomes. Linberg et al. [8] reported that there is no statistically valid correlation between the size of the neo-ostium and the final size of the healed intranasal ostium. On the other hand, Rosen et al. [1] showed that the endocanalicular approach usually creates smaller neo-ostia than the external and endonasal approach, and this is correlated with lower success rates of ECL DCR. In our study, we concluded that endonasal interventions enabled us to obtain larger neo-ostium without excessive laser energy based on our outcomes, but the neo-ostium size was not documented, and this was one of our drawbacks [4]. After gaining more experience with ECL DCR, and recognizing the high synechia incidence in cases in which no endonasal procedures were applied, we abandoned the performance of ECL DCR without endonasal procedures after the middle of 2008. We conducted a prospective randomized comparative study on 91 patients with primary All the authors have full control of all primary data, and agree to allow Graefe's Archive for Clinical and Experimental Ophthalmology to review their data upon request. H. Basmak (*) :H. Gursoy Department of Ophthalmology, Eskisehir Osmangazi University Medical Faculty, Eskisehir, Turkey e-mail: hbasmak@ogu.edu.tr

Revison endonasal dacryocystorhinostomies: analysis of 44 procedures

To determine the success rate of revision endoscopic dacryocystorhinostomies (DCR) and to analyse 44 revision DCRs. The operative and postoperative data were collected in 44 revision DCRs. The corrections of associated structural anatomic alterations were performed during the surgery (resection of the scarr, the bone window creating, resection of the head of the middle turbinate, septoplasty, ethmoidectomy etc.) and the intubation was performed in all cases. The follow-up interval ranged from 12 to 36 months. The 44 ReEDCRs were performed in adults and there were only 5 children under the age of 15. The surgery was performed under local or general anaesthesia. The most frequent secondary procedures were scar resections, creating a wider bone window, and partial middle turbinate resection. Four patients were excluded for their follow-up periods had not been completed. An average time of the tubes removal was 5.6 months. The total success rate was 84.0%; the success rate was 85.7% in the group with closed rhinostomy and 1/2 in the group of canalicular and rhinostomy obstructions. The endonasal revision DCR is a safe and very effective surgical procedure following the failed DCRs. The correction of associated structural anatomic alterations that may be involved in the failure of previous surgeries can be easily performed.

B005 Cochlear implantation in very young children

Endoscopic endonasal transplanum and transsellar approaches are frequently utilized to manage pituitary adenomas, craniopharyngiomas, and meningiomas. In addition to the intrinsic panoramic view from the endoscope, wide access using both nostrils and a posterior septectomy can aid in both visualization and complete tumor removal. When necessary, a posterior ethmoidectomy and/or partial middle turbinate resection can be used to improve access. Recognizing key anatomic landmarks from an endonasal viewpoint such as the sella turcica, tuberculum sella, planum sphenoidale, internal carotid arteries, and optic nerves is critical. For sellar surgery, a wide sellar opening can be created from the tuberculum to the sellar floor and laterally to the medial cavernous sinus wall while maintaining the sellar dura. For transplanum approaches, the lateral bony osteotomies parallel the optic canals and are connected to the planum osteotomy that is slightly anterior to the tumor extent. The tuberculum sella can then be removed to expose the sphenoid limbus, a reliable landmark for the optic apparatus. Reconstruction of these skull base defects ranges from simple to complex depending on the size, flow of cerebrospinal fluid (CSF), and degree of intracranial dissection. Vascularized mucoperiosteal flaps like the nasoseptal flap have reduced the rates of postoperative CSF leak. Either early harvest of the nasoseptal flap or preservation of the vascular pedicle is advocated to increase the reconstructive options.

Beeinflusst die Resektion der mittleren "Turbinate" (Concha) die Erfolgsrate der endonasalen Dacryocystorhinostomie?

BACKGROUND: To evaluate if the partial resection of the head of the middle turbinate increases a patency of the rhinostomy in the primary endonasal dacryocystorhinostomies (EDCR). METHODS: The definite evidence-based determination of the relative efficacy of partial turbinectomy on EDCR has not been established in the literature so far. The partial middle turbinate resection is performed during EDCRs in patients with the anteriorly enlarged middle turbinate or in whom the lacrimal sac projection on the lateral nasal wall is covered with the anteriorly located head of the middle turbinate to prevent rhinostomy closure. The data were retrospectivelly collected in 639 primary EDCRs performed in the patients over 16 years old in the period 1994–2008. Only the patients with subsaccal nasolacrimal duct obstructions were involved in the study (233 cases); the patients with canalicular obstructions and secondary surgical procedures (silicone intubation, Mitomycin C, ethmoidectomy, septoplasty) were excluded. The success rates of patients with the partial middle turbinate resection (group I) and without resection (group II) were compared one year after the surgery. RESULTS: The overall success rate was 217/233 (93.1%) in EDCRs with/without partial turbinate resections. In group I the success rate was 96/99 (96.9%), in group II 121/134 (90.3%). The differences between the results in groups I and II were statistically significant (p < 0.05). CONCLUSIONS: The partial middle turbinate resection significantly improves the success rate in the primary EDCRs.

Failures in endoscopic surgery of the maxillary sinus

Objective To assess the prognostic factors of recurrence after endoscopic sinus surgery for maxillary chronic rhinosinusitis without nasal polyps. Study Design Prospective. Setting Tertiary referral center. Methods A total of 411 patients were operated on for maxillary chronic rhinosinusitis without nasal polyps (307 rhinogenic rhinosinusitis, 74 odontogenic rhinosinusitis, and 30 oroantral fistula cases) in a single institution between 2002 and 2007. Ten parameters were analyzed to study their relationship with recurrence: etiology of rhinosinusitis, partial resection of middle turbinate, smoking history, allergy, asthma, gastroesophageal reflux, preoperative endoscopic score, CT stage, maxillary sinus mucosa score, and bleeding score. Preoperative characteristics and recurrence rates were compared with the analysis of variance test. Failure was analyzed as a time-dependent variable by the Kaplan-Meier method. Variables identified on univariate analysis were entered into a multivariate Cox proportional hazards model. Results Recurrent rhinosinusitis developed in 28 (6.8%) cases. In the univariate analysis, preoperative endoscopic score, CT stage, and bleeding score were associated with recidivism. However, the multivariate analysis suggested that only bleeding is an independent predictive factor of recurrence ( P = 0.034, 95% confidence interval for odds ratio 0.92-7.21). Conclusion Intraoperative bleeding may be a risk factor for failure in endoscopic surgery of maxillary rhinosinusitis, but there is substantial uncertainty and future research is needed.

Management of the middle turbinate during functional endoscopic sinus surgery

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.

Incidence of frontal sinusitis following partial middle turbinectomy.

The role of partial middle turbinate resection as an adjunct to endoscopic sinus surgery is controversial. Recent literature suggests that middle turbinate resection may have a detrimental effect on the frontal sinus. A retrospective analysis of 155 consecutive patients undergoing partial middle turbinate resection utilizing the technique of the senior author (J.A.D.) for either sinusitis or nasal obstruction was conducted. The data reveal a low rate of frontal sinusitis following partial middle turbinectomy (10%). None of the patients undergoing partial middle turbinectomy for nasal obstruction developed frontal sinusitis postoperatively. No major complications were encountered. Frontal sinusitis following middle turbinectomy was often associated with preoperative comorbidity such as asthma, nasal polyps, severe disease score on computed tomography, or diseased middle turbinates. The authors conclude that partial middle turbinectomy for treatment of sinusitis and nasal obstruction has a low incidence of postoperative frontal sinusitis. Development of frontal sinusitis may be predictable on the basis of several comorbid factors.

Initial report on postoperative healing after endoscopic sinus surgery with the microdebrider

Synechiae formation is a frequent occurrence after endoscopic sinus surgery and may cause symptomatic sinus outflow tract obstruction. Various means are used to reduce the incidence of synechiae formation. These include meticulous operative technique, partial middle turbinate resection, middle meatus spacers or stents, and postoperative debridement. The microdebrider is a powered rotary shaving device that precisely resects tissue, minimizing inadvertent mucosal trauma and stripping. We present 40 cases of endoscopic sinus surgery performed with the microdebrider. Patients had at least a 5-month follow-up and demonstrated rapid mucosal healing, minimal crust formation, and a low incidence of synechiae formation. These initial data suggest that the microdebrider may be advantageous in surgery for chronic sinusitis. (Otolaryngol Head Neck Surg 1998;118:800-3.)