The Forgotten Turbinate: The Role of the Superior Turbinate in Endoscopic Sinus Surgery

Abstract

The fate of the middle turbinate in endoscopic sinus surgery has been a subject of debate for some time. The superior turbinate's role, however, has been largely passed over. Past anatomic descriptions and illustrations have given surgeons the incorrect impression that this structure is well superior and out of the field of dissection. Injury to the superior turbinate may account for postoperative hyposmia. The superior turbinate also serves as a constant landmark for the sphenoethmoidal recess, and a limited resection allows the surgeon to identify and include the natural ostium of the sphenoid sinus in the sphenoidotomy. The embryology and anatomy of the superior turbinate are reviewed. An approach to the natural ostium of the sphenoid sinus from the lateral side of the middle turbinate, using the superior turbinate as a guide, is described.

Role of the superior turbinate when performing endoscopic endonasal transsphenoidal approach

“…A p value < 0.05 was accepted as statistically significant. referred to the superior turbinate as a reliable anatomical landmark of the sphenoid sinus and its natural ostium [2,13,15,16,18]. Most reports state that the natural ostium of the sphenoid sinus is positioned medial to the superior turbinate [2,16].…”

“…Orlandi et al [18] reported on the use of the superior turbinate as a constant, reliable landmark for the natural ostium of the sphenoid sinus. When the posterior por-…”

The Sinonasal Anatomy: Endoscopic Lacrimal and Orbital Perspectives

“…These turbinates originate from the ethmoid bone. The superior turbinate has the common attachment of the middle turbinate to the skull base [ 39 ]. The supreme turbinate may be found in up to 65 % of specimens [ 9 ].…”

The safe gate to the posterior paranasal sinuses: reassessing the role of the superior turbinate

“…In 1999, a group of eminent rhinologists from a number of American centres published two articles to describe a technique for identiWcation of the superior turbinate and utilizing it as a landmark in endoscopic posterior ethmoidectomy and sphenoidotomy [2,4] Although this was more than a decade ago, there have not been, to the best of our knowledge, any further articles conWrming or contradicting the operative experience of the above group. There have been, however, several articles presenting cadaveric and/or radiological studies of the superior turbinate [5][6][7][8][9].…”

“…The authors of the current article have routinely used the technique published in 1999 [2,4] for identiWcation of the superior turbinate, and relying upon it as a landmark during endoscopic surgery involving the posterior ethmoid and sphenoid sinuses. In addition, we have further modiWed the technique by attempting to identify the two parts of the basal lamella of the superior turbinate.…”