Suture medialization of the middle turbinates during endoscopic sinus surgery

December 1, 2008     Kim M. Hewitt, MD and Richard R. Orlandi, MD


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.

Superior turbinate pneumatization in patients with chronic rhinosinusitis: Prevalence on paranasal sinus CT

September 25, 2008     Seth J. Kanowitz, MD, Annette O. Nusbaum, MD, Joseph B. Jacobs, MD, and Richard A. Lebowitz, MD


With the availability of high-resolution computed tomography (CT), a great deal of attention has been paid to the anatomy of the paranasal sinuses. But while investigators have focused on the osteomeatal complex and its relation to chronic rhinosinusitis, there has been little discussion of the superior turbinate. Although a few anatomic studies have tried to quantify pneumatization of the superior turbinate, the prevalence of this finding on radiography is not well addressed in the literature. We prospectively studied 100 consecutively presenting patients who underwent coronal CT of the paranasal sinuses (200 sides) for the evaluation of symptoms of chronic rhinosinusitis at an academic tertiary referral center to determine the prevalence of pneumatization of the superior turbinate. We found evidence of pneumatization in 44 of the 200 sides, for a prevalence of 22%. In all, pneumatized superior turbinates were found in 27 patients (27%)—bilaterally in 17 (17%) and unilaterally in 10 (10%).

Office CO2 laser turbinoplasty

June 30, 2008     Gordon J. Siegel, MD, Kristin A. Seiberling, MD, Kenneth G. Haines, MD, Kenneth G. Haines, MD, and Allison S. Aguado, MD


We conducted a prospective study of office carbon dioxide (CO2) laser turbinoplasty as a treatment for symptoms related to turbinate dysfunction in 58 patients. All patients completed surveys before and 1 month after treatment, and 23 patients completed longer-term follow-up surveys 8 to 24 months postoperatively. The 1-month postoperative assessments demonstrated a trend toward symptom improvement, as many patients reported a decrease in their use of pretreatment medications. Long-term benefit was achieved in 70% of patients. Ten patients underwent pre- and post-treatment biopsies, and histologic evaluation demonstrated minimal tissue alteration following treatment, alleviating concerns of physiological and functional compromise. We conclude that office-based CO2 laser turbinoplasty is a useful tool for the treatment of disorders related to turbinate dysfunction. We describe one clinician's method of performing office CO2 laser turbinoplasty, and we report his experience and findings.

Cavernous hemangioma of the middle turbinate: A case report

June 30, 2008     Fatma Çaylakli, MD, Alper Can Çağici, MD, Cem Hürcan, MD, Nebil Bal, MD, Osman Kizilkiliç, MD, and Fikret Kiroglu, MD


Most cavernous hemangiomas present at birth or soon after. Cavernous hemangiomas of the nasal cavity, which are rare, usually do not present until adulthood; their incidence peaks in the fourth decade of life. Most affected patients experience epistaxis or hemoptysis and an enlarging lesion in the nose. Histologically, cavernous hemangiomas appear as closely packed, dilated vascular channels lined with a layer of flattened endothelial cells. We describe the case of a 32-year-old man who was admitted to our clinic with the complaint of a nasal obstruction. On anterior rhinoscopy, he was found to have a hypervascularized and hypertrophied left middle turbinate and septal deviation. Computed tomography and magnetic resonance imaging of the paranasal sinuses demonstrated a well-defined cystic lesion that had arisen within the bony left middle turbinate and caused deviation of the septum to the right. The lesion was excised via endoscopic surgery with general anesthesia. No complications occurred during the postoperative period. Histologic examination identified the tumor as a cavernous hemangioma. To the best of our knowledge, this is the first case reported in the English-language literature of a cavernous hemangioma appearing as a cystic mass in the middle turbinate.

Endoscopic view of a septated concha bullosa

February 1, 2008     Eiji Yanagisawa, MD, FACS, Joseph P. Mirante, MD, FACS, and Dewey A. Christmas, MD

Unilateral inferior turbinate hypoplasia caused by a longstanding (approximately 35 yr) nasal foreign body

January 1, 2008     Fiorenza Derosas, MD, Gino Marioni, MD, Brescia Giuseppe, MD, Alessandra Florio, MD, Claudia Staffieri, MD, and Alberto Staffieri, MD


We report the unusual case of a 44-year-old man who presented with a plastic foreign body that had been lodged in his right nasal cavity for approximately 35 years. Initial attempts to remove the object were unsuccessful; only after it was broken into several parts was removal achieved. Rigid nasal endoscopy and computed tomography revealed hypoplasia of the ipsilateral inferior turbinate.

Unilateral inferior turbinate agenesis: A case report

January 1, 2008     Fatma Çaylakli, MD, Ismail Yilmaz, MD, Cem Hürcan, MD, Cem Özer, MD, and Levent Özlüoĝlu, MD


Many common anatomic variations in the nasal cavity have been observed, including paradoxical turbinates and pneumatization of the inferior, middle, and superior turbinates. We describe a case of a rare anomaly—unilateral inferior turbinate agenesis—in a 65-year-old man who had presented with epistaxis. During evaluation, anterior rhinoscopic examination revealed the absence of the right inferior turbinate; this finding was confirmed on computed tomography. The patient had never undergone nasal or sinus surgery, and he denied ever having expelled anything of significance from his nasal cavity. This case merits attention because of the rarity of reports on turbinate agenesis.

Endoscopic view of a hyperpneumatized agger nasi cell resembling a nasal turbinate

December 1, 2007     Eiji Yanagisawa, MD, FACS, Joseph P. Mirante, MD, FACS, and Dewey A. Christmas, MD

Endoscopic view of sinonasal cancer 6 years post-treatment

October 31, 2007     Dewey A. Christmas Jr., MD, Joseph P. Mirante, MD, FACS, and Eiji Yanagisawa, MD, FACS

Dislocation of the turbinate: A rare complication of middle turbinate surgery

May 31, 2007     Hisham S. Khalil, MD, FRCS (ORL-HNS); Arash H. Naraghi, MRCS; Desmond A. Nunez, MD, FRCS (ORL)

Endoscopic view of a powered partial resection of a concha bullosa

March 1, 2007     Dewey A. Christmas, Jr., MD; Joseph P. Mirante, MD, FACS, MBA; Eiji Yanagisawa, MD, FACS

Epistaxis caused by hemangioma of the inferior turbinate

September 30, 2006     Joseph P. Mirante, MD; Dewey A. Christmas, MD; Eiji Yanagisawa, MD
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