Middle turbinate resection is unlikely to cause empty nose syndrome in first year postoperatively

Law, Richard H.; Ahmed, Abdelrahman; Harn, Meredith Van; Craig, John R.

doi:10.1016/j.amjoto.2021.102931

Cited by 9 publications

(8 citation statements)

References 40 publications

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Section: Methodsmentioning

confidence: 99%

“…In this cohort, 97.9% of patients had ENS6Q scores that were within normal limits at the date of their last follow-up and 93.7% had no visible crusting at the date of their last follow-up. 53 Implications for clinical practice: In the majority of EEA cases, MTs can be preserved. MT preservation does not appear to be associated with iatrogenic obstructive sinusitis.…”

Section: Turbinate Preservationmentioning

confidence: 99%

See 1 more Smart Citation

Optimizing Quality of Life and Minimizing Morbidity through Nasal Preservation in Endoscopic Skull Base Surgery: A Contemporary Review

Pinheiro‐Neto

Rowan

Celda

et al. 2022

J Neurol Surg B Skull Base

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Introduction Endoscopic endonasal approaches (EEAs) are increasingly utilized for intracranial pathology. As opposed to sinonasal tumors, the nasal cavity is being used as a corridor to access these intracranial tumors but is not the site of primary surgical intent. Accordingly, there has been recent interest in preserving intranasal structures not directly involved by tumor and improving postoperative sinonasal quality of life (QOL). Objectives The aim of the study is to highlight recent advances in EEA techniques focused on improving sinonasal QOL including turbinate preservation, reducing the morbidity of reconstructive techniques, and the development of alternative minimally invasive EEA corridors. Methods The method of the study involves contemporary literature review and summary of implications for clinical practice. Results Nasoseptal flap (NSF) harvest is associated with significant morbidity including septal perforation, prolonged nasal crusting, and external nasal deformities. Various grafting and local rotational flaps have demonstrated the ability to significantly limit donor site morbidity. Free mucosal grafts have re-emerged as a reliable reconstructive option for sellar defects with an excellent sinonasal morbidity profile. Middle turbinate preservation is achievable in most EEA cases and has not been shown to cause postoperative obstructive sinusitis. Recently developed minimally invasive EEA techniques such as the superior ethmoidal approach have been described to better preserve intranasal structures while allowing intracranial access to resect skull base tumors and have shown promising sinonasal QOL results. Conclusion This contemporary review discusses balancing effective skull base reconstructive techniques with associated morbidity, the role of turbinate preservation in EEA, and the development of unique EEA techniques that allow for increased nasal structure preservation.

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Section: Methodsmentioning

confidence: 99%

Section: Turbinate Preservationmentioning

confidence: 99%

Optimizing Quality of Life and Minimizing Morbidity through Nasal Preservation in Endoscopic Skull Base Surgery: A Contemporary Review

Pinheiro‐Neto

Rowan

Celda

et al. 2022

J Neurol Surg B Skull Base

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“…64 However, long-term evidence has demonstrated that MTR improves intraoperative and postoperative visualization, sinus ventilation, and the availability of topically administered medications with fewer long-term complications than originally postulated. 65,66 Evidence also suggests that MTR confers durable prevention of polyp recurrence in a large cohort of patients followed over several years. 67 Although the practice of MTR has become more widely accepted, further studies to determine the extent of MTR as well as the optimal surgical candidates are warranted.…”

Section: Maxillary Sinusmentioning

confidence: 99%

Advances in Sinus Surgery for Nasal Polyps

Norwood

Grayson

Woodworth

2023

Am J Rhinol�Allergy

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Background Chronic rhinosinusitis with nasal polyps (CRSwNP) is comprised of a diverse group of endotypes that cause significant morbidity for afflicted patients. While endoscopic sinus surgery helps ameliorate the disease, polyps frequently recur. Newer strategies are intended to provide access for topical steroid irrigations in attempts to improve the disease process and quality of life, and decrease overall recurrence of polyps. Objective To review the current literature examining the latest surgical approaches for CRSwNP. Methods Review article. Results In dealing with the recalcitrant nature of CRSwNP, surgical techniques have simultaneously become more nuanced and aggressive. Bony resection in anatomically unfavorable areas such as the frontal, maxillary, and sphenoid outflow regions, replacing diseased or denuded mucosa with healthy grafts or flaps at the neo-ostia, and introducing drug-eluting biomaterials to newly opened sinus outflow tracts are highlights in the recent advancements in sinus surgery for CRSwNP. The Draf 3 or modified endoscopic Lothrop procedure has become a standard technique and demonstrated to improve quality of life and decrease polyp recurrence. A number of mucosal grafting or mucosal flap techniques have been described that cover exposed bone of the neo-ostium and evidence shows that this improves healing and diameter of the Draf 3. Partial middle turbinectomy, while controversial, appears to help decrease polyp recurrence in long-term follow-up studies. Modified endoscopic medial maxillectomy improves access to the maxillary sinus mucosa, facilitates debridement and, particularly, in the cystic fibrosis nasal polyp patient, improves overall management of the disease. Sphenoid drill-out procedure provides wider access for topical steroid irrigations and also may improve management of CRSwNP. Conclusion Surgical intervention remains a mainstay of therapy for CRSwNP. Newer techniques revolve around improving access for topical steroid therapy.

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“…Although over aggressive resection of the inferior turbinate is the most common culprit of ENS, resection of the MT has been implicated in the past [13]. A prospective study published in 2021 analyzed 95 consecutive patients who underwent bilateral MT resection during ESS with extended frontal sinusotomy (Draf 2B and Draf 3) and found that 2.1% of patients had elevated scores defined as ≥ 11 on the Empty Nose Syndrome 6-Item Questionnaire (ENS6Q) [14 ▪ ]. The mean ENS6Q was 2.1 ± 2.7 in this study, suggesting low risk for ENS in this cohort.…”

Section: Introductionmentioning

confidence: 99%

Management of the middle turbinate during and after sinus surgery

Tang

Roxbury

2021

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose of reviewTreatment of the middle turbinate (MT) during and after endoscopic sinus surgery (ESS) has been controversial. Historically, there has been concern that resection of the MT may result in smell loss and frontal sinus stenosis. However, these concerns must be balanced by knowledge that a residual diseased MT may result in surgical failure. This review discusses the current evidence on treatment of the MT during and after ESS. Recent findingsSeveral review articles have shown the safety of performing MT resection. Studies have not shown increase rates of frontal sinus stenosis, olfactory loss, or empty nose syndrome. However, the benefit of MT resection is highly debated. There have also been many recent advances and technological developments to assist in management of the postoperative MT.

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Middle turbinate resection is unlikely to cause empty nose syndrome in first year postoperatively

Cited by 9 publications

References 40 publications

Optimizing Quality of Life and Minimizing Morbidity through Nasal Preservation in Endoscopic Skull Base Surgery: A Contemporary Review

Optimizing Quality of Life and Minimizing Morbidity through Nasal Preservation in Endoscopic Skull Base Surgery: A Contemporary Review

Advances in Sinus Surgery for Nasal Polyps

Management of the middle turbinate during and after sinus surgery

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