Influence of shape of middle turbinate on development of recurrent rhinosinusitis

Abstract

In the presence of a paradoxically curved middle nasal turbinate, treatment tactics may be different. To achieve the best effect in the treatment of chronic rhinosinusitis, in some cases, a complete resection of the middle nasal turbinate is performed. However, in this group of patients in the postoperative period, complaints may appear from the quality of nasal breathing, which is associated with the development of paradoxically difficult breathing, when with sufficient passage of the air jet, the patient complains of difficulty in nasal breathing. Also, these patients are characterized by a decrease in the sense of smell. It is important that the absence of the middle nasal turbinate during repeated surgical interventions deprives the surgeon of an important anatomical landmark. We want to share a clinical example in which we received a positive outcome of surgical treatment in a patient with chronic left-sided rhinosinusitis in the presence of a paradoxically curved middle nasal turbinate and a slightly deviated nasal septum. In order to restore ventilation of the anterior group of the paranasal sinuses, the lateral part of the paradoxically curved middle nasal turbinate was removed with its preservation and expansion of the natural anastomosis of the maxillary sinus. In the postoperative period, the patient noted a significant improvement in her condition and did not make any previous complaints. This clinical case demonstrates that the middle nasal turbinate plays an important role in the functioning of the nasal cavity, in particular the osteomeatal complex, and in various anatomical variants can disrupt its work, both in combination with other structural features of the lateral nasal wall, and in isolation. In this connection, during the surgical treatment, a sparing, organ-preserving technique was chosen in order to preserve the functions of the middle turbinate, which in the postoperative period led to the achievement of a stable positive result.