Knot-free suture medialization of the middle turbinate

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.

Impact of Suture Conchopexy on Olfaction and the Risk of Middle Turbinate Lateralization

Introduction: Middle turbinate (MT) lateralization is one of the common causes of endoscopic sinus surgery (ESS) failure and often necessitate revision surgery. To avoid this sequala, surgeons have attempted several methods to keep the MT medialized. One such method is conchopexy. However, the impact of this procedure on olfaction remains unclear.

Method: A retrospective cohort study was conducted to compare the subjective olfaction outcome of ESS in patients for whom conchopexy was performed and in controls where a spacer was applied in the middle meatus. Also, the risk of lateralization in both techniques was compared. In addition, other factors related to the outcome of olfaction, such as age, gender, type of chronic rhinosinusitis (CRS), and partial resection of the MT, were assessed.

Results: Out of 299 patients with CRS who underwent ESS, 134 met our inclusion criteria. In total, 62.7% were male and 37.3% were female, and their mean age was 37.4 years. Sixty-one patients (cases) underwent conchopexy, and 73 patients (controls) underwent insertion of a middle meatus spacer. None of the subjects in both groups developed anosmia or hyposmia as a complication. The improvement of olfaction was almost equal in both groups (for anosmia: 92.9% in cases vs. 87.5% in control; for hyposmia 87.1% in cases vs. 89.7% in control). In patients with anosmia, the improvement of olfaction was lower when the MT was partially resected (71.4% vs. 95.7%); whereas, in patients with hyposmia, the improvement was not significantly different (87% vs. 93.8% when the MT was partially resected). The improvement of olfaction was higher in patients with allergic fungal sinusitis (AFS) and CRS with nasal polyps (CRSwNP) than in those with CRS without nasal polyps (CRSsNP). The MT lateralization was almost equal in both groups (9.0% in cases vs. 9.6% in controls).

Conclusion: Conchopexy does not affect olfaction subjectively. The improvement of olfaction is related more to the underlying disease, i.e., less improvement occurs in cases of CRSsNP. The risk of lateralization is equal with either conchopexy or middle meatus spacer.

Comprehensive review on endonasal endoscopic sinus surgery

Endonasal endoscopic sinus surgery is the standard procedure for surgery of most paranasal sinus diseases. Appropriate frame conditions provided, the respective procedures are safe and successful. These prerequisites encompass appropriate technical equipment, anatomical oriented surgical technique, proper patient selection, and individually adapted extent of surgery. The range of endonasal sinus operations has dramatically increased during the last 20 years and reaches from partial uncinectomy to pansinus surgery with extended surgery of the frontal (Draf type III), maxillary (grade 3-4, medial maxillectomy, prelacrimal approach) and sphenoid sinus. In addition there are operations outside and beyond the paranasal sinuses. The development of surgical technique is still constantly evolving. This article gives a comprehensive review on the most recent state of the art in endoscopic sinus surgery according to the literature with the following aspects: principles and fundamentals, surgical techniques, indications, outcome, postoperative care, nasal packing and stents, technical equipment.