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Clinical Challenges
January 1998

Middle Turbinate Resection: Weighing the Decision

Author Affiliations
 

KAREN H.CALHOUNMDRONALD B.KUPPERSMITHMD

Arch Otolaryngol Head Neck Surg. 1998;124(1):106-107. doi:10.1001/archotol.124.1.106

CONSIDERABLE controversy exists concerning the appropriateness of MT resection during endoscopic sinus surgery. The views on this topic vary to either extreme. Some say the MT should never be resected in the absence of a concha bullosa, while others routinely resect at least a portion of the MT (the so-called turbinators).

Most surgeons who advocate partial MT resection do so for practical rather than theoretical reasons, including ease of postoperative care, decreased synechia formation, and higher middle meatal antrostomy patency rates. As Stewart has pointed out, what little data exist would seem to support this practical approach.

Those who condemn MT resection often do so for theoretical reasons, including limited knowledge of the functional importance of the MT, the potential for leakage of cerebrospinal fluid caused by damage to the olfactory epithelium, and opening the middle meatus to greater exposure to allergens and other toxins during nasal respiration.

In most published series on the efficacy of endoscopic sinus surgery, synechia formation is the most common, although minor, complication, with the next most frequent complication being stenosis of the middle meatal antrostomy. Therefore, it would seem that any technique that would lessen these problems should be adopted by all nasal surgeons.

While the theoretical disadvantages seem to be just that—theoretical—it may be that long-term follow-up is necessary for certain adverse effects to become manifest. In addition, one must always bear in mind that confounding procedures, such as septoplasty and inferior turbinoplasty, may complicate analysis of the effect of MT resection.

Any potential for leakage of cerebrospinal fluid and damage to the olfactory epithelium seems overrated. I know of no reported case of either occurring from simple partial MT resection, although, of course, this procedure would rarely be performed in isolation.

An approach that I feel is rational and the one I have used for years is as follows: if the patient has a normal MT and a relatively wide middle meatus, following completion of the endoscopic procedure I leave the MT undisturbed. In this situation, if the mucosa on the lateral surface is undisturbed, synechia formation is uncommon and postoperative care is still relatively easy.

On the other hand, if the MT has a concha bullosa, is paradoxically bent, or if the middle meatal space is narrow on completion of the procedure, I resect part of the MT, specifically, the anterior-inferior portion. To date, I have not observed a complication from resecting the anterior-inferior part of the MT in these circumstances.

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