Jay M Dutton1, Mark J Hinton. 1. Department of Otolaryngology and Bronchoesophagology, Rush University Medical Center, Chicago, Illinois, USA. jay_dutton@rush.edu
Abstract
BACKGROUND: One of the primary goals of endoscopic sinus surgery (ESS) is to create widely patent paranasal sinus ostia, and lateralization of a middle turbinate (MT) after ESS can obstruct otherwise patent ethmoid and maxillary sinuses. Numerous methods have been used to assist in the avoidance of this complication including the use of packing in the ethmoid sinus as a "spacer," controlled creation of synechia between the MT and septum, and suture medialization of the MT to the septum. The latter is an effective technique, but because the olfactory groove lies superior in the groove between the MT and septum, concerns have been raised as to the effect of this maneuver on olfaction. The aim of this pilot study was to objectively evaluate olfaction before and after suture conchopexy, and, secondarily, to evaluate the effectiveness of this technique in preventing lateralization of the MT. This study was designed to assess the effect of suture medialization of the MT during ESS on olfactory sensation. METHODS: Objective assessment of olfactory function using the University of Pennsylvania Smell Identification Test (UPSIT) was performed before and 6 months after ESS in 153 patients between January 2006 and January 2008. Postoperative follow-up exams were also performed to determine the effectiveness of the medialization procedure and the patency of the ethmoid cavities. RESULTS: UPSIT testing showed a small but statistically significant improvement in olfactory function after MT suture medialization to the septum when compared with preoperative assessment. Postoperative endoscopic examination revealed that lateralization of the MT was a rare complication after suture medialization of the MT. CONCLUSION: MT suture medialization during ESS is an effective method for preventing lateralization of the MT and does not impair olfactory function.
BACKGROUND: One of the primary goals of endoscopic sinus surgery (ESS) is to create widely patent paranasal sinus ostia, and lateralization of a middle turbinate (MT) after ESS can obstruct otherwise patent ethmoid and maxillary sinuses. Numerous methods have been used to assist in the avoidance of this complication including the use of packing in the ethmoid sinus as a "spacer," controlled creation of synechia between the MT and septum, and suture medialization of the MT to the septum. The latter is an effective technique, but because the olfactory groove lies superior in the groove between the MT and septum, concerns have been raised as to the effect of this maneuver on olfaction. The aim of this pilot study was to objectively evaluate olfaction before and after suture conchopexy, and, secondarily, to evaluate the effectiveness of this technique in preventing lateralization of the MT. This study was designed to assess the effect of suture medialization of the MT during ESS on olfactory sensation. METHODS: Objective assessment of olfactory function using the University of Pennsylvania Smell Identification Test (UPSIT) was performed before and 6 months after ESS in 153 patients between January 2006 and January 2008. Postoperative follow-up exams were also performed to determine the effectiveness of the medialization procedure and the patency of the ethmoid cavities. RESULTS: UPSIT testing showed a small but statistically significant improvement in olfactory function after MT suture medialization to the septum when compared with preoperative assessment. Postoperative endoscopic examination revealed that lateralization of the MT was a rare complication after suture medialization of the MT. CONCLUSION: MT suture medialization during ESS is an effective method for preventing lateralization of the MT and does not impair olfactory function.
Authors: Fernando Cesar Mariano; Rogerio Hamerschmidt; Caio Marcio Correa Soares; Ana Tereza Moreira Journal: Int Arch Otorhinolaryngol Date: 2017-12-06