xRead - Nasal Obstruction (September 2024) Full Articles

20426984, 2021, 3, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/alr.22741 by Stanford University, Wiley Online Library on [01/07/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License

589

Orlandi et al.

preservation at 1 year postoperatively, whereas there were no differences between the groups by 3 and 5 years after operation. 2020 However, a multicenter study demon strated similar improvements in SNOT-22 and EuroQol 5 Dimension questionnaire between MT preservation and resection groups, 2040 which was consistent with Byun’s findings 2041 in SNOT-20. Soler and colleagues, 2042 how ever, found that although MT resection was associated with improved endoscopy scores vs MT preservation, there was no difference in QoL. A recent RCT showed that there was no sustained objective endoscopic benefit of MT resection. 2043 With conflicting results from similar quality studies, it is difficult to definitively determine the possible QoL benefit of MT resection. Medication Delivery. Only 1 study showed that after MT resection in 4 cadaver heads, irrigation delivery signifi cantly improved. 2044 Postoperative Frontal Sinusitis. In 1995 Swanson and colleagues 2045 reported that patients had a higher risk of frontal sinusitis with MT resection. Other studies demon strated that patients undergoing MT resection had 10% to 18% postoperative rate of frontal sinusitis. 2046,2047 How ever, 2 more recent studies compared MT resection to preservation and found no difference in the rate of frontal sinusitis. 2048,2049 Collectively these results cast doubt on the significance of MT resection as a risk factor for post operative frontal sinusitis. Recurrence of Nasal Polyps. Brescia 2050 and Byun 2041 found MT preservation associated with lower nasal polyps scores 12 months after ESS. Similarly, Marchioni and colleagues 2051 found a trend toward a lower recurrence rate (although without statistical significance) effect of MT resection in their prospective cohort. Subsequently, Wu and colleagues 2052 found a longer median time to recur rence of NPs with MT resection compared to that with MT preservation. These authors noted, however, that a greater burden of disease preoperatively might possibly account for the difference in endoscopy scores. Overall, it appears MT resection reduces or slows the recurrence of nasal polyps. Olfaction . Two prospective cohort studies have shown no effect on olfaction following MT resection, 2053,2054 whereas another 2 prospective cohort studies 2042,2055 and 1 retrospective review 2056 have shown a beneficial effect. Akiyama and colleagues 2057 found significantly better olfactory cleft patency in the submucosal MT resection group than in the control group without MT resection. In this prospective randomized double-blind trial, improve ments were observed in the olfactory recognition thresh old test scores after submucosal middle turbinectomy com bined with ESS. Kim and colleagues 2058 investigated the effect of preservation of MT by medialization and found no impairment of olfactory function. With regard to olfac

tion, the aggregated data of similar low level studies show conflicting results. Maxillary Ostial Stenosis . Three studies have shown no effect of MT resection on maxillary patency, 2048,2059,2060 whereas there was a positive effect for MT resection in 1 earlier retrospective study. 2061 However, it appears from these data that MT resection does not have a significant effect on middle meatal antrostomy patency. Middle Turbinate Synechiae . Two retrospective reviews indicated no effect of MT resection on synechiae formation between the MT and the lateral nasal wall. 2062,2063 Intraoperative Cerebrospinal Fluid (CSF) Leak. Amulti center case series reported that partial MT resection led to CSF leak in only 1 case out of 91 patients following partial or complete MT resection. 2064 Development of “Empty Nose Syndrome.” Tan and colleagues 2065 found that partial MT resection did not sig nificantly increase the risk of developing the condition commonly referred to as empty nose syndrome compared to MT preservation. Postoperative Bleeding. The MT has a rich blood supply from a branch of the sphenopalatine artery. Previous stud ies have reported that MT resection was associated with the risk of postoperative bleeding. 2050,2066–2069 Recently, Miller and colleagues 2070 found that there was a signifi cantly increased minor bleeding rate correlated with MT resection. However, in the multicenter case series (n = 91) found no postoperative epistaxis after partial or complete MT resection. 2064 Orbital Complications. One retrospective review found that MT absence after previous surgery was associated with an increased risk of nasolacrimal duct stenosis, lamina papyracea injury and orbital hematoma during revision ESS. 2071 In conclusion, rigid adherence to MT preservation or routine MT resection is not supported by the available cumulative evidence. Additional, definitive evidence is warranted to investigate the valid indications for MT preservation and resection. To be noted, currently, there are no head-to-head studies comparing partial vs total MT resection, which should be further studied in the future. At present, management of the MT requires a thoughtful approach with considerations of all potential risks, bene fits, and alternatives.

Middle Turbinate Preservation or Resection in Sinus Surgery Aggregate Grade of Evidence: C (Level 2: 4 studies; level 3: 11 studies; level 4: 15 studies; Table XII-19).