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Novarria GA, Vultaggio F, Saginario V, Felisati G, Saibene AM. Efficacy and safety of middle turbinate surgery: a systematic review. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08825-4. [PMID: 38992192 DOI: 10.1007/s00405-024-08825-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 07/02/2024] [Indexed: 07/13/2024]
Abstract
PURPOSE Middle turbinate (MT) surgery is extremely common during endoscopic sinus surgery procedures, though no agreement exists on which techniques provide the best outcomes. This PRISMA-compliant systematic review aims to assess which MT surgery technique yields the least postoperative adverse effects and the best objective and subjective outcomes. METHODS A comprehensive search criteria was conducted in multiple databases up to July 3, 2023, to identify studies reporting surgical treatments of the MT. After screening and quality assessment, 14 articles were included for analysis. Data on patients demographics, surgical approaches, postoperative treatment and follow-up, objective and subjective outcomes were extracted and reviewed. RESULTS Out of 173 unique papers identified, 14 articles met the inclusion criteria, predominantly randomized controlled trials (n = 9). Antero-inferior middle turbinectomy was the predominant surgical approach. Most studies evaluated results with postoperative endoscopy, a superior outcome was documented in the intervention group (ten out of eleven cases). In four out five studies using the SNOT-22, the treatment group was associated with a statistically significant improvement. Olfactory questionnaires highlighted superior olfactory outcome in two out of three studies. The UPSIT score revealed no significant difference between groups. Objective olfactory assessments favored treatment groups in both studies utilizing olfactometry. CONCLUSIONS It seems that a partial MT surgical approach consistently yields subjective and objective improvements compared to conservative measures, also suggesting a positive impact on smell function. Despite it appears that better outcomes with fewer complications are consistently achieved with partial techniques, it remains challenging identifying which partial technique surpasses the others, due to significant heterogeneity among the studies.
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Affiliation(s)
- Gabriele Alessandro Novarria
- Department of Otolaryngology and Head and Neck Surgery, Istituto Clinico Città Studi, Via Jommelli 17, Milano, 20131, Italy.
| | - Federica Vultaggio
- Department of Clinical Sciences and Community Health, San Giuseppe Hospital, Università Degli Studi di Milano, Milan, Italy
| | - Vittorio Saginario
- Department of Otolaryngology and Head and Neck Surgery, Istituto Clinico Città Studi, Via Jommelli 17, Milano, 20131, Italy
| | - Giovanni Felisati
- Department of Health Sciences, Otorhinolaryngology Unit, Santi Paolo e Carlo Hospital, University of Milan, Milan, Italy
| | - Alberto Maria Saibene
- Department of Health Sciences, Otorhinolaryngology Unit, Santi Paolo e Carlo Hospital, University of Milan, Milan, Italy
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Al-Salihi MM, Rahman M, Al-Jebur MS, Al-Salihi Y, Shihadeh O, Hammadi F, Ayyad A. Effect of preservation versus resection of turbinate on olfactory function in endoscopic trans-nasal trans-sphenoidal pituitary surgery: a systematic review and meta-analysis. Neurol Res 2024; 46:444-452. [PMID: 38467610 DOI: 10.1080/01616412.2024.2328493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/03/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Utilizing endoscopes in surgery offers advantages and concerns, including potential nasal function impacts. Hyposmia following Transseptal Transsphenoidal hypophysectomy ranges from 0% to 2.2%. Debates persist about managing the M.T. in endoscopic sinus surgery due to its impact on nasal function. While preservation is recommended for sinonasal health, debates continue, as certain cases require resection. Our meta-analysis aims to compare turbinate resection and preservation effects on olfactory function. METHODS We searched five electronic databases to collect all relevant studies. Records were screened for eligibility. Data were extracted from the included studies independently. Our continuous outcomes were pooled as standardized mean difference with 95% CI. Statistical analyses was done by RevMan. RESULTS Our meta-analysis included four studies involving 235 patients (81 males). Evaluating changes in olfaction scores, two one-month studies (82 patients) revealed no significant difference between preservation and resection groups (Std.MD = 0.05[-0.39, 0.50], p = 0.81). For three-month assessments (146 patients), SNOT tests indicated no significant difference (Std.MD = 0.21, 95% CI[-0.11, 0.54], p = 0.20). Two studies used other tests on 70 patients at three months, yielding no significant difference (Std.MD = 0.13, 95% CI [-0.35, 0.62], p = 0.59). Two six-month studies (72 patients) similarly found no significant difference (Std.MD = 0.09, 95% CI [-0.39, 0.56], p = 0.72). CONCLUSION Our meta-analysis involving 235 patients examined olfaction score changes over various time frames in trans-nasal trans-sphenoidal pituitary surgeries. No significant differences were observed between turbinate preservation and resection groups at one month, three months, or six months post-surgery.
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Affiliation(s)
- Mohammed Maan Al-Salihi
- Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Mohammed Rahman
- Department of Neurosurgery, St. Marys Hospital, Decatur, IL, USA
| | | | | | - Omar Shihadeh
- Department of Neurosurgery, Hamad General Hopsital, Doha, Qatar
| | - Firas Hammadi
- Department of Neurosurgery, Hamad General Hopsital, Doha, Qatar
| | - Ali Ayyad
- Department of Neurosurgery, Hamad General Hopsital, Doha, Qatar
- Department of Neurosurgery, Saarland University Hospital, Homburg, Germany
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Ramirez-Gil LS, Ley-Tomas JJ, Hernaiz-Leonardo JC, Alobid I, Mullol J, Ceballos-Cantu JC. Effects of Endoscopic Sinus Surgery on Olfactory Function. Curr Allergy Asthma Rep 2023; 23:715-731. [PMID: 38038879 DOI: 10.1007/s11882-023-01115-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 12/02/2023]
Abstract
PURPOSE OF REVIEW To review the effects of endoscopic sinus surgery and endonasal approaches to the skull base on olfaction. RECENT FINDINGS Advancements in endonasal endoscopic approaches to the sinuses and skull base allow for direct treatment of a variety of sinonasal and skull base diseases. However, these extended approaches will often require manipulation of normal anatomical structures and the olfactory neuroepithelium. Depending on the planned procedure and extent of disease, the prognosis of olfactory perception can vary significantly among patients. Endoscopic sinonasal surgical procedures may impact olfaction. Optimizing olfactory function requires proper surgical techniques, gentle handling of tissue, and perioperative care. Surgeons must discuss objectives and manage patient expectations. Routine olfactory assessment is crucial in surgical work-up and follow-up. Preserving anatomical structures while addressing the obstruction of the olfactory cleft helps to prevent decreased olfactory threshold. However, smell identification and discrimination do not always correlate with sinonasal anatomy.
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Affiliation(s)
- L Stefano Ramirez-Gil
- Department of Otolaryngology-Head and Neck Surgery, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Vasco de Quiroga 15 Tlalpan, CDMX 14080, Mexico
| | - J J Ley-Tomas
- Department of Otolaryngology-Head and Neck Surgery, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosío Villegas, CDMX, Mexico
| | - J C Hernaiz-Leonardo
- Department of Otolaryngology - Head and Neck Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Isam Alobid
- Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic. Barcelona, Barcelona, Catalonia, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS), Barcelona, Catalonia, Spain
- Universitat de Barcelona., Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Joaquim Mullol
- Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic. Barcelona, Barcelona, Catalonia, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS), Barcelona, Catalonia, Spain
- Universitat de Barcelona., Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - J C Ceballos-Cantu
- Department of Otolaryngology-Head and Neck Surgery, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Vasco de Quiroga 15 Tlalpan, CDMX 14080, Mexico.
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Hsu PY, Hsieh LC, Wang YH, Chen SJ, Chan YK, Shen KH, Wang YP. Olfactory Outcomes After Middle Turbinate Resection in Endoscopic Transsphenoidal Surgery: A Prospective Randomized Study. Otolaryngol Head Neck Surg 2022; 167:964-970. [PMID: 35316101 DOI: 10.1177/01945998221086202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Endoscopic endonasal transsphenoidal surgery is safe and effective for sellar and parasellar tumor removal. Partial middle turbinate (MT) resection is sometimes performed to optimize the surgical field and facilitate postoperative care. Disturbances in olfaction are concerning because of the lack of randomized studies in this field. STUDY DESIGN Prospective randomized trial. SETTING Single academic medical center. METHODS We resected the lower halves of bilateral MTs in the resected group and laterally fractured bilateral MTs in the preserved group. Olfactory outcomes and sinonasal conditions were assessed by using the validated Taiwan Smell Identification Test and Lund-Kennedy Endoscopy Score, respectively. Forty-nine patients were enrolled in the final analysis, of whom 23 underwent partial MT resection. RESULTS The average Taiwan Smell Identification Test result was 36.9 one month after surgery, with a significant change of -4.4 ± 3.1 (mean ± SD; P < .01) from baseline. The impact was not significant at 3 months (-2.1 ± 2.6, P = .13) or 6 months (0.3 ± 2.0, P = .79). Between the MT resection and preservation groups, there were no significant differences at postoperative 1 month (P = .60), 3 months (P = .86), and 6 months (P > .99). Lund-Kennedy Endoscopy Score was still higher at 3 months (P = .006) after surgery but returned to the preoperative level at 6 months (P = .63). CONCLUSIONS Endoscopic endonasal transsphenoidal surgery may affect olfaction at 1 month after surgery, and olfactory function is expected to return after 3 months. Partial MT resection did not result in additional olfactory loss. It is safe to perform partial MT resection during surgery without compromising the olfactory outcomes.
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Affiliation(s)
- Pei-Yuan Hsu
- Department of Otolaryngology-Head and Neck Surgery, Mackay Memorial Hospital, Taipei
| | - Li-Chun Hsieh
- Department of Otolaryngology-Head and Neck Surgery, Mackay Memorial Hospital, Taipei.,School of Medicine, Mackay Medical College, New Taipei City.,Department of Audiology and Speech Language Pathology, Mackay Medical College, New Taipei City
| | - Yu-Hsuan Wang
- Department of Otolaryngology-Head and Neck Surgery, Mackay Memorial Hospital, Taipei
| | - Shiu-Jau Chen
- School of Medicine, Mackay Medical College, New Taipei City.,Department of Neurosurgery, Mackay Memorial Hospital, Taipei
| | - Yun-Kai Chan
- Department of Neurosurgery, Mackay Memorial Hospital, Taipei
| | - Kuang-Hsuan Shen
- Department of Otolaryngology-Head and Neck Surgery, Mackay Memorial Hospital, Taipei
| | - Ying-Piao Wang
- Department of Otolaryngology-Head and Neck Surgery, Mackay Memorial Hospital, Taipei.,School of Medicine, Mackay Medical College, New Taipei City.,Department of Audiology and Speech Language Pathology, Mackay Medical College, New Taipei City
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Bolger WE, Lockett E, Bolger IM. Anosmia following middle nasal concha resection: an anatomic and developmental review with clinical correlation. Clin Anat 2022; 35:873-882. [PMID: 35417061 DOI: 10.1002/ca.23883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/09/2022] [Accepted: 04/09/2022] [Indexed: 11/06/2022]
Abstract
Losing the sense of smell can be associated with a significant decrease in quality of life. Fortunately, this occurs infrequently with modern paranasal sinus surgery that has stressed minimally invasive, tissue-sparing principles. However, over time, more extensive surgical applications have emerged that incorporate increased tissue removal. Post-operative period sequelae can occur, including anosmia. Understanding the potential implications of expanded tissue removal, such as middle nasal concha (turbinate) resection, is clinically important and is facilitated by an understanding of anatomy. Our understanding of anatomic nuances is enhanced through an appreciation of embryonic and fetal development. We herein review the developmental anatomy of the middle nasal concha of the ethmoid sinus and olfactory nerve area as it relates to middle nasal concha removal during endoscopic sinus surgery. We present images from our analysis of twelve embryonic and fetal specimens that highlight the important relationship between the middle nasal concha and olfactory nerves. We also review the clinical issues surrounding turbinate preservation versus resection and present a clinical correlation to underscore the uncommon but significant complication of anosmia following sinus surgery with middle nasal concha resection. We highlight knowledge gaps, discuss case selection and review surgical technique modifications for middle nasal concha surgery to reduce the chance of this complication in the future. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- William E Bolger
- Professor of Otorhinolaryngology, University of Florida, School of Medicine, Jacksonville, Florida
| | - Elizabeth Lockett
- Collections Manager Human Developmental Anatomy Center, National Museum of Health and Medicine, Silver Spring, Maryland, United States
| | - Ian M Bolger
- Neuroscience Program, College of Sciences, Georgia Institute of Technology
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