Abstract
Objective
Resection of middle turbinate in the setting of endoscopic sinus surgery is a controversial procedure. Our aim is to assess the impact of the anterior part middle turbinoplasty on the outcome of endoscopic sinus surgery, incidence of synechia between the middle turbinate and the lateral nasal wall, intra- and post-operative accessibility to the paranasal sinuses.
Methods
Single blinded randomized controlled study of 120 patients with chronic rhinosinusitis without polyps, they were allocated into two groups, we performed anterior part middle turbinoplasty in the group one “60 patients”, and we preserved the middle turbinate in the group two “60 patients”. We assessed the patients pre-operatively by Sino-nasal outcome Test (SNOT-22), intra-operatively by Likert scale score for the sinuses accessibility. At least 6 months post-operatively, we assessed the patients by SNOT-22, and Likert scale score for sinus accessibility.
Results
During and after surgery, the Likert scale score in the group one showed statistically significant better sinuses accessibility than in the group two. We noticed synechia between the MT and the lateral nasal wall in 9.2% and 18.2% of the operated sides in group one and group two, respectively. SNOT-22 and its smell item improved significantly in both groups with no statistically significant differences between them. No major complications were reported.
Conclusion
Anterior part middle turbinoplasty is a safe and effective technique during endoscopic sinus surgery to improve the intra- and post-operative sinus accessibility, and decrease the incidence of post-operative synechia, with no adverse effect on olfaction or bleeding.
Similar content being viewed by others
Data availability
The corresponding author can provide data to back up the findings of this study upon request. Due to privacy and ethical concerns, the data is not publicly available.
Code availability
NAD.
References
Hopkins C, Browne JP, Slack R, Lund V, Brown P (2007) The Lund-Mackay staging system for chronic rhinosinusitis: how is it used and what does it predict? Otolaryngol Head Neck Surg 137:555–561
Wigand ME, Steiner W, Jaumann MP (1978) Endonasal sinus surgery with endoscopical control: from radical operation to rehabilitation of the mucosa. Endoscopy 10:255–260
Wolf JSBJ (2001) The middle turbinate in endoscopic sinus surgery. Curr Opin Otolaryngol Head Neck Surg 9:23–26
Friedman M, Caldarelli DD, Venkatesan TK, Pandit R, Lee Y (1996) Endoscopic sinus surgery with partial middle turbinate resection: effects on olfaction. Laryngoscope 106:977–981
Friedman M, Landsberg R, Tanyeri H (2000) Middle turbinate medialization and preservation in endoscopic sinus surgery. Otolaryngol Head Neck Surg 123:76–80
Minovi ASB, Drad W (2009) Complications of endonasal endoscopic sinus surgery. In: Stucker FJ, de Souza C, Kenyon GS, Lian TS, Draf W, Schick B (eds) Rhinology and facial plastic surgery. Verlag, Berlin Heidelberg, pp 587–592
Fokkens WJ, Lund VJ, Hopkins C et al (2020) European position paper on rhinosinusitis and nasal polyps. Rhinology 58:1–464
Lund VJ, Mackay IS (1993) Staging in rhinosinusitus. Rhinology 31:183–184
Alanazy F, Dousary SA, Albosaily A, Aldriweesh T, Alsaleh S, Aldrees T (2018) Psychometric Arabic sino-nasal outcome test-22: validation and translation in chronic rhinosinusitis patients. Ann Saudi med 38:22–27
Soy FK, Pinar E, Imre A, Calli C, Calli A, Oncel S (2013) Histopathologic parameters in chronic rhinosinusitis with nasal polyposis: impact on quality of life outcomes. Int Forum Allergy Rhinol 3:828–833
Scott NA, Wormald P, Close D, Gallagher R, Anthony A, Maddern GJ (2003) Endoscopic modified Lothrop procedure for the treatment of chronic frontal sinusitis: a systematic review. Otolaryngol Head Neck Surg 129:427–438
Soler ZM, Smith TL (2010) Quality-of-life outcomes after endoscopic sinus surgery: how long is long enough? Otolaryngol Head Neck Surg 143:621–625
Smith TL, Mendolia-Loffredo S, Loehrl TA, Sparapani R, Laud PW, Nattinger AB (2005) Predictive factors and outcomes in endoscopic sinus surgery for chronic rhinosinusitis. Laryngoscope 115:2199–2205
Bhattacharyya N (2004) Symptom outcomes after endoscopic sinus surgery for chronic rhinosinusitis. Arch Otolaryngol Head Neck Surg 130:329–333
Mace JC, Michael YL, Carlson NE, Litvack JR, Smith TL (2010) Correlations between endoscopy score and quality of life changes after sinus surgery. Arch Otolaryngol Head Neck Surg 136:340–346
Poetker DM, Mendolia-Loffredo S, Smith TL (2007) Outcomes of endoscopic sinus surgery for chronic rhinosinusitis associated with sinonasal polyposis. Am J Rhinol Allergy 21:84–88
Toffel PH (2003) Secure endoscopic sinus surgery with partial middle turbinate modification: a 16 year long-term outcome report and literature review. Curr Opin Otolaryngol Head Neck Surg 11:13–18
Rice DH (1998) Middle turbinate resection: weighing the decision. Arch Otolaryngol Head Neck Surg 124:106
Messerklinger W (1985) Endoscopic diagnosis and surgery of recurrent sinusitis. In: Krajira Z (ed) Advances in nose and sinus surgery. Zagreb University, Zagreb (CR)
Lebowitz RA, Doud Galli SK, Lee KC, Jacobs JB (2001) Management of the middle turbinate during functional endoscopic sinus surgery. Oper Tech Otolayngol Head Neck Surg 12:13–16
Biedlingmaier JF (1996) The middle turbinate window approach in endoscopic sinus surgery. Oper Tech Otolayngol Head Neck Surg 7:275–277
LaMear WR, Davis WE, Templer JW, McKinsey JP, Del Porto H (1992) Partial endoscopic middle turbinectomy augmenting functional endoscopic sinus surgery. Otolaryngol Head Neck Surg 107:382–389
Lee KB, Jeon YS, Chung SK (2016) Kim SK (1992) Effects of partial middle turbinectomy with varying resection volume and location on nasal functions and airflow characteristics by CFD. Comput Biol Med 77:214–221
Kennedy DW (1998) Middle turbinate resection: evaluating the issues—should we resect normal middle turbinates? Arch Otolaryngol Head Neck Surg 124:107
Féron F, Perry C, McGrath JJ, Mackay-Sim A (1998) New techniques for biopsy and culture of human olfactory epithelial neurons. Arch Otolaryngol Head Neck Surg 124:861–866
Pinna Fde R, Ctenas B, Weber R, Saldiva PH, Voegels RL (2013) Olfactory neuroepithelium in the superior and middle turbinates: which is the optimal biopsy site? Int Arch Otorhinolaryngol 17:131–138
Tan NC, Goggin R, Psaltis AJ, Wormald PJ (2018) 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. Int Forum Allergy Rhinol 8:959–963
Soler ZM, Hwang PH, Mace J, Smith TL (2010) Outcomes after middle turbinate resection: revisiting a controversial topic. Laryngoscope 120:832–837
Biedlingmaier JF (1993) Endoscopic sinus surgery with middle turbinate resection: results and complications. Ear Nose Throat J 72:351–355
Biedlingmaier JF, Whelan PJ (1996) Analysis for olfactory epithelium using olfactory marker protein on endoscopically harvested middle turbinates. Am J Rhinol 10:221–224
Giacchi RJ, Lebowitz RA, Jacobs JB (2000) Middle turbinate resection: issues and controversies Am. J Rhinol 14:193–197
Fortune DS, Duncavage JA (1998) Incidence of frontal sinusitis following partial middle turbinectomy. Ann Otol Rhinol Laryngol 107:447–453
Saidi IS, Biedlingmaier JF, Rothman MI (1998) Pre- and postoperative imaging analysis for frontal sinus disease following conservative partial middle turbinate resection. Ear Nose Throat J 77:326–328
Halderman AA, Stokken J, Sindwani R (2016) The effect of middle turbinate resection on topical drug distribution into the paranasal sinuses. Int Forum Allergy Rhinol 6:1056–1061
Wu AW, Ting JY, Platt MP, Tierney HT, Metson R (2014) Factors affecting time to revision sinus surgery for nasal polyps: a 25 year experience. Laryngoscope 124:29–33
Biedlingmaier JF, Whelan P, Zoarski G, Rothman M (1996) Histopathology and CT analysis of partially resected middle turbinates. Laryngoscope 106:102–104
Davis WE, Templer JW, Lamear WR, Davis WE Jr, Craig SB (1991) Middle meatus anstrostomy: patency rates and risk factors. Otolaryngol Head Neck Surg 104:467–472
Funding
There were no funding resources for our study.
Author information
Authors and Affiliations
Contributions
MOT contributed in clinical examination, surgery, collecting the data, writing and preparation of manuscript; MNE-S, HE-B, MA-GH, and AE-N contributed in material preparation, data collection and analysis.
Corresponding author
Ethics declarations
Conflict of interest
All authors declare that they have no conflict of interest (financial or non-financial).
Ethical approval
The institutional review board of the Faculty of medicine, University of Tanta.
Informed consent
We had an informed consent from all the participants of our study. Only members of the research team have collected the patient information from the electronic case records and reviewed it.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Tomoum, M.O., ElSheikh, M.N., ElBasty, H. et al. Anterior part middle turbinoplasty in endoscopic sinus surgery: a randomized controlled study. Eur Arch Otorhinolaryngol 279, 2465–2471 (2022). https://doi.org/10.1007/s00405-021-07053-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00405-021-07053-4