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

Tan, Neil; Goggin, Rachel K.; Psaltis, Alkis James; Wormald, Peter‐John

doi:10.1002/alr.22127

Cited by 24 publications

(16 citation statements)

References 19 publications

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“…Development of “Empty Nose Syndrome.” Tan and colleagues 2065 found that partial MT resection did not significantly increase the risk of developing the condition commonly referred to as empty nose syndrome compared to MT preservation.…”

Section: Surgery For Chronic Rhinosinusitismentioning

confidence: 99%

International consensus statement on allergy and rhinology: rhinosinusitis 2021

Orlandi

Kingdom

Smith

et al. 2021

Int Forum Allergy Rhinol

Self Cite

525

479

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I. Executive Summary Background The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS.

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Section: Surgery For Chronic Rhinosinusitismentioning

confidence: 99%

International consensus statement on allergy and rhinology: rhinosinusitis 2021

Orlandi

Kingdom

Smith

et al. 2021

Int Forum Allergy Rhinol

Self Cite

525

479

View full text Add to dashboard Cite

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“…They found no difference in total ENS6Q scores between the MTR and MT preservation groups. 11 Further well-designed studies will be necessary to determine the relationship between MTR and ENS.…”

Section: Discussionmentioning

confidence: 99%

“…One complication that occurs in 1%-27% of ESSs is MT lateralization with or without synechia formation to the lateral nasal wall or medial orbital wall (Figure 1). [7][8][9][10][11] MT scarring to the medial orbital wall can cause frontal sinus outflow stenosis, frontal sinusitis or mucocele, and may require revision ESS. 12,13 MT lateralization can impair postoperative access for sinus debridement as well as monitoring for sinus disease recurrence.…”

Section: Introductionmentioning

confidence: 99%

Complications Are Rare From Middle Turbinate Resection: A Prospective Case Series

Pinther

Deeb

Peterson

et al. 2019

Am J Rhinol�Allergy

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Background When chronic rhinosinusitis with nasal polyps (CRSwNP) fails to respond to medical therapy, endoscopic sinus surgery (ESS) plays an integral role in management. Some studies have shown that middle turbinate resection (MTR) during ESS leads to decreased polyp recurrence and revision ESS rates. Other studies suggest MTR can lead to complications. Objective The purpose of this study was to assess the safety of MTR during ESS for CRSwNP by determining the incidences of intraoperative cerebrospinal fluid (CSF) leak, postoperative epistaxis requiring operative intervention, and postoperative complete frontal stenosis. Methods A multiinstitutional, prospective case series of 91 adult CRSwNP patients was conducted. Patients with medically refractory CRSwNP underwent primary or revision ESS plus MTR by 3 surgeons. Two of the surgeons performed partial MTRs, and one of the surgeons performed complete MTRs. Patients were evaluated for the following complications: intraoperative CSF leak during MTR, postoperative epistaxis requiring operative intervention, and postoperative complete frontal ostial stenosis. Secondary outcomes included changes from preoperative to postoperative 22-item Sinonasal Outcome Test (SNOT-22) scores and revision ESS rates. Results Unilateral or bilateral complete ESSs with MTRs were performed on 91 CRSwNP patients. In total, 173 MTRs were performed. Two surgeons performed 97 partial MTRs on 49 patients, and the third surgeon performed 76 complete MTRs on 42 patients. One CSF leak occurred during partial MTR (1/173, 0.57%). No patients suffered postoperative epistaxis requiring operative intervention, and no patients developed complete frontal stenosis. From preoperatively to postoperatively, mean SNOT-22 scores decreased from 53.7 to 13.1 ( P = .001). No revision ESS was needed during the follow-up period. Mean follow-up time was 7.5 ± 5.4 months. Conclusions Partial and complete MTR during ESS for CRSwNP in this cohort resulted in very low, acceptable intraoperative and short-term postoperative complication rates and no detriment to SNOT-22 scores.

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“…While MTR is generally well tolerated without subsequent reduction in quality of life or development of atrophic rhinitis, resection is typically only advocated in patients with sinus disease, especially those with severe nasal polyposis. 10-12…”

Section: Discussionmentioning

confidence: 99%

Middle Turbinate Friendly Technique for Cribriform Cerebrospinal Fluid Leak Repair

Luk

Ikeda

Wise

et al. 2019

Otolaryngol.--head neck surg.

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ObjectiveTo compare surgical outcomes between 2 techniques for cribriform cerebrospinal fluid leak (CSF) repair with middle turbinate preservation (MTP) vs middle turbinate resection (MTR). A secondary outcome is to examine the effectiveness of collagen dura matrix (CDM) as a grafting material for repair of isolated cribriform skull base defects.Study DesignA retrospective chart review was performed of consecutive patients who underwent cribriform CSF repair at Emory University over the past 15 years.SettingTertiary care rhinology practice.SubjectsAdult patients with cribriform defects limited to the cribriform plate that did not extend lateral to the middle turbinate (MT) and were reconstructed with a free graft (mucosal or synthetic).MethodsPatients were stratified into 2 primary groups by surgical technique: MTP vs MTR. A subset of patients underwent repair with CDM alone and was analyzed separately for CSF repair failure rate.ResultsOf 68 patients identified with cribriform defects, 42 underwent repair with MTP and 26 underwent repair with MTR. Average follow-up time was 495 days. Patients with idiopathic intracranial hypertension were also equally distributed ( P = .20). Primary CSF leak repair success was 95.6%, with 100% of leaks ultimately repaired. A subset of 39 patients underwent repair with CDM alone, with a primary repair success rate of 94.9%.ConclusionsWe present an effective method for repair of cribriform CSF leaks while preserving the MT. CDM can be successfully used as a free graft alone for repair of isolated cribriform CSF leaks.

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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

Cited by 24 publications

References 19 publications

International consensus statement on allergy and rhinology: rhinosinusitis 2021

International consensus statement on allergy and rhinology: rhinosinusitis 2021

Complications Are Rare From Middle Turbinate Resection: A Prospective Case Series

Middle Turbinate Friendly Technique for Cribriform Cerebrospinal Fluid Leak Repair

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