Middle turbinate medialization for improved access during endoscopic sinus surgery

Abstract

Multiple techniques have been described to prevent lateralization of the middle turbinate. It is our opinion that implementing the proposed technique at the start of the surgery allows for optimal exposure during the operation.

Solitary chemosensory cells producing interleukin‐25 and group‐2 innate lymphoid cells are enriched in chronic rhinosinusitis with nasal polyps

“…Selected patients were refractory to medical management for CRSwNP and were therefore undergoing functional endoscopic sinus surgery and polypectomy from the ethmoid sinuses. To obtain healthy control mucosa from the same patient, an 8 mm by 4 mm mucosal strip was taken from the medial aspect of the middle turbinate to induce scarring to the septum (ie, bolgerization) in attempts to prevent lateralization of the middle turbinate after surgery . Middle turbinates were inspected for any polypoid degeneration, and patients demonstrating polypoid degeneration of their middle turbinate were excluded from this study.…”

Knot‐free suture medialization of the middle turbinate

“…8,9 It allows for prevention of the bothersome complication of turbinate lateralization without requiring uncomfortable postoperative packing or use of more expensive stenting materials.…”

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T he middle turbinate has long been recognized as a key structure in endoscopic sinus surgery. 4,8,9 This technique has been criticized for being technically difficult and time consuming, mainly due to the need to tie a knot within the nasal cavity. 1 While in the past there has been controversy over whether the middle turbinate should be resected or maintained in place, 2 many experts prefer to conserve the structure in most cases.

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“…3 This leads to a discrete incidence of lateralization of the middle turbinate and scarring against the lateral nasal wall, which can lead to obstruction of the middle meatus and the need for revision procedures. 4,8,9 This technique has been criticized for being technically difficult and time consuming, mainly due to the need to tie a knot within the nasal cavity. These include middle meatal packing, stent, or spacer placement 5 and controlled synechiae formation between the middle turbinate and the septum, both via abrasion formation 6 as well as other means.…”

Turbinate‐septal suture for middle turbinate medialization: A prospective randomized trial

“…Turbinate‐septal suturing techniques have been evaluated and are of use . The techniques are simple to implement and effective at preventing MT lateralization.…”