Suture medialization of the middle turbinates during endoscopic sinus surgery

December 1, 2008
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Abstract

Adhesion of the middle turbinate to the lateral nasal wall is a common complication of endoscopic sinus surgery. The potential sequela of middle turbinate lateralization is obstruction of the middle meatus and the maxillary, ethmoid, or frontal sinuses, which can result in recurrent sinus disease and often necessitate revision surgery. While various materials and stents have been developed to prevent middle turbinate adhesion to the lateral nasal wall, suture medialization of the middle turbinate to the nasal septum with an absorbable suture has the potential to be just as successful without causing the discomfort associated with other methods. We conducted a retrospective review of suture medializations of 157 middle turbinates in 85 patients who had undergone endoscopic sinus surgery to ascertain the incidence of postoperative middle turbinate adhesion to the lateral nasal wall. We found that adhesions developed in 17 middle turbinates (10.8%) in 15 patients; the remaining 140 middle turbinates (89.2%) were free of scarring. Thirteen of the 17 adhesions were easily divided in the outpatient clinic setting during routine postoperative endoscopic care, meaning that only 4 of the 157 turbinates (2.5%) demonstrated synechiae that remained problematic after routine care. We conclude that the development of clinically significant adhesions following suture medialization of the middle turbinate is uncommon. Suture medialization should be considered as an alternative to middle meatal packing or stenting to prevent adhesions following endoscopic sinus surgery.

Introduction

Endoscopic sinus surgery has become the standard of care for the treatment of medically refractory chronic rhinosinusitis. The most frequently reported complication is adhesion of the lateral aspect of the middle turbinate to the lateral nasal wall.1,2 The potential sequela of turbinate lateralization and scarring is obstruction of the middle meatus and the maxillary, ethmoid, or frontal sinus ostia. This complication may contribute to a recurrence of sinus disease and perhaps necessitate revision surgery.

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