Middle turbinate resection: impact on outcomes in endoscopic sinus surgery.Abstract
There is considerable controversy concerning the advisability and efficacy of middle turbinate turbinate /tur·bi·nate/ (-nat)
1. shaped like a top.
2. any of the nasal conchae.
tur·bi·nate or tur·bi·nat·ed
1. Shaped like a top.
2. resection in endoscopic en·do·scope
An instrument for examining visually the interior of a bodily canal or a hollow organ such as the colon, bladder, or stomach.
en sinus surgery. Some have reported that it causes an increase in the incidence of frontal sinusitis sinusitis
Inflammation of the sinuses. Acute sinusitis, usually due to infections such as the common cold, causes localized pain and tenderness, nasal obstruction and discharge, and malaise. while others have .found no such association. Surprisingly, in a 35-year review of turbinate surgery literature, Clement and White did not find a single prospective study of turbinate surgery. In this article, we briefly report our prospective study of middle turbinate resection during endoscopic sinus surgery. Our findings lead us to believe that middle turbinate resection has no deleterious effects on the results of endoscopic sinus surgery.
There is considerable disagreement concerning the advisability and efficacy of middle turbinate resection in endoscopic sinus surgery. Messerklinger felt that with few exceptions, the middle turbinate should be preserved. (1) Among these exceptions were cases of concha bullosa Concha Bullosa is an abnormal pneumatization of the middle turbinate which may interfere with normal ventilation of sinus ostia and can result in recurrent sinusitis. and a paradoxically bent middle turbinate; in such eases, partial resection was recommended. Wigand et al, on the other hand, recommended partial or total middle turbinectomy as a routine early step in endoscopic sinus surgery. (2) However, neither Messerklinger nor Wigand et al provided any scientific rationale for their respective approaches. Nevertheless, both techniques have yielded excellent results.
The recent literature has not clarified the controversy. Swanson et al reported an increased incidence of frontal sinusitis following middle turbinate resection. (3) Others have found no such association and, in fact, have reported an increase in middle mental patency pa·ten·cy
The state or quality of being open, expanded, or unblocked.
the condition of being open. rates. (4,5) But all of these studies were retrospective and therefore subject to the usual limitations of such investigations. In fact, in a review of 35 years of articles on turbinate surgery, Clement and White did not find a single prospective study. (6) In this article, we briefly describe the results of the first prospective study of middle turbinate resection during endoscopic sinus surgery.
Patients and methods
Our study population consisted of 31 consecutive patients who had bilateral, symmetrical chronic sinusitis chronic sinusitis Chronic sinus infection ENT Inflammation of the sinuses that empty into the nasal cavity Etiology Allergic rhinitis, nasal obstruction, deviated nasal septum, tooth abscesses, URIs that had not responded to medical management. Computed tomography Computed tomography (CT scan)
X rays are aimed at slices of the body (by rotating equipment) and results are assembled with a computer to give a three-dimensional picture of a structure. revealed that disease in all patients involved at least the ethmoid ethmoid /eth·moid/ (eth´moid)
1. sievelike; cribriform.
2. the ethmoid bone; see Table of Bones. .ethmoi´dal
eth·moid or eth·moi·dal
adj. and maxillary sinuses.
Endoscopic sinus surgery was performed by the senior author (D.H.R.) in the usual manner with one exception--the right middle turbinate was resected and the left middle turbinate was undisturbed. Resection of the right middle turbinate was performed in a modified Wigand fashion as described by Fortune and Duncavage, (4) while treatment of the left middle turbinate was performed as recommended by Messerklinger. (1) Thus, each patient served as his or her own control.
All patients were followed for a period of 6 months to 2 years. Eight patients developed postoperative adhesions--four on the right, three on the left, and one bilaterally. Four patients experienced one episode each of bilateral sinusitis during the follow-up period; only one case involved the frontal sinus frontal sinus
A hollow formed on either side in the lower part of the squama of the frontal bone, communicating by the ethmoidal infundibulum with the middle meatus of the nasal cavity of the same side. . All cleared rapidly with antibiotic therapy.
Much of the controversy surrounding middle turbinate resection seems to involve matters of philosophy and personal beliefs concerning nasal physiology. Real evidence-based data are scant. As noted earlier, neither Messerklinger nor Wigand et al offered any solid scientific reasons for their disparate and strongly held beliefs. Much of the controversy may exist because the precise physiology of the middle turbinate is poorly understood. Clearly, the mucus blanket carries trapped particles to the pharynx pharynx (fâr`ĭngks), area of the gastrointestinal and respiratory tracts which lies between the mouth and the esophagus. In humans, the pharynx is a cone-shaped tube about 4 1-2 in. (11.43 cm) long. while it also humidifies and warms inspired air. What is less certain is the relative plasticity of the nasal tissue and its ability to assume this function in the absence of the middle turbinate. There is also a point at which the loss of nasal tissue cannot compensate, a condition known as empty-nose syndrome.
Over the years, many authors have observed that there is more to the problem than concha bullosa and a paradoxically bent middle turbinate. In these situations, resection of the middle turbinate seemed to be beneficial. Furthermore, no deleterious effects have been observed by most authors. But the conservative thinkers among us worry about inadvertent harm from over-resection of nasal tissue.
Our prospective study was performed to provide some answers. Because reputable rhinologists both decry de·cry
tr.v. de·cried, de·cry·ing, de·cries
1. To condemn openly.
2. To depreciate (currency, for example) by official proclamation or by rumor. and advocate middle turbinate resection, we selected patients who had bilaterally symmetrical Adj. 1. bilaterally symmetrical - capable of division into symmetrical halves by only one longitudinal plane passing through the axis
biological science, biology - the science that studies living organisms
2. disease. The right middle turbinate was always resected and the left was always undisturbed in order to eliminate any selection bias.
Based on our findings, it would appear that middle turbinate resection has no deleterious effects on the results of endoscopic sinus surgery--at least in the absence of other complicating factors, such as a loss of additional nasal tissue.
(1.) Messerklinger W. Endoskopische diagnose and chirurgie der rezidivierender sinusitis. In: Krajira Z, ed. Advances in Nose and Sinus Surgery. Zagreb: Zagreb University, 1985.
(2.) Wigand ME, Steiner W, Jaumann MP. Endonasal sinus surgery with endoscopical control: From radical operation to rehabilitation of the mucosa. Endoscopy endoscopy
Examination of the body's interior through an instrument inserted into a natural opening or an incision, usually as an outpatient procedure. Endoscopes include the upper gastrointestinal endoscope (for the esophagus, stomach, and duodenum), the colonoscope (for the 1978;10:255-60.
(3.) Swanson P, Lanza DC, Kennedy DW, Vining EM. The effect of middle turbinate resection upon frontal sinus disease. Am J Rhinol 1995;9:191-5.
(4.) Fortune DS, Duncavage JA. Incidence of frontal sinusitis following partial middle turbinectomy. Ann Otol Rhinol Laryngol 1998; 107:447-53.
(5.) Havas TE, Lowinger DS. Comparison of functional endonasal sinus surgery with and without partial middle turbinate resection. Ann Otol Rhinol Laryngol 2000; 109:634-40.
(6.) Clement WA, White PS. Trends in turbinate surgery literature: A 35-year review. Clin Otolaryngol 2001;26:124-8.
From the Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California The U.S. News & World Report ranked USC 27th among all universities in the United States in its 2008 ranking of "America's Best Colleges", also designating it as one of the "most selective universities" for admitting 8,634 of the almost 34,000 who applied for freshman admission , Los Angeles Los Angeles (lôs ăn`jələs, lŏs, ăn`jəlēz'), city (1990 pop. 3,485,398), seat of Los Angeles co., S Calif.; inc. 1850. .
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John Doe (Member): Middle Turbinectomy 8/17/2010 5:02 PM
I can help you with your study.
I had my middle turbinates resected.
It has caused me tremendous pain, dryness, and disrupted my air flow.
Its time ENTs stand up and be ethical. Stop being so pro surgery, be more conservative, and stop cutting parts out of people's bodies - no other type of surgeon resects people's body parts like this so freely.