A common belief amongst pituitary surgeons is that lateralising the middle turbinate to access the sphenoid can result in an iatrogenic sinusitis. This paper attempts to find out whether this is in fact true. Thirty-eight patients fitted the inclusion criteria for analysis. Seventeen of these had pituitary surgery, 18/35 had sphenoidotomy for other pathology and 3/38 had surgery to repair a CSF leak. CT scans were evaluated before and after surgery and the amount of middle turbinate lateralisation was measured in millimetres.

The middle turbinates of 31 patients showed an element of lateralisation. A sinusitis symptom score was recorded using a visual analogue scale pre- and postoperatively. Although a small patient sample was studied, results showed no statistically significant increase in sinusitis symptoms as a result of middle turbinate lateralisation.

This was despite the senior author’s preferred surgical technique of avoiding pack insertion between the middle turbinate and lateral wall or using a suture to medialise the middle turbinates. Interestingly, the evidence from this paper does not support the hypothesis that a lateralised middle turbinate increases the incidence of an iatrogenic sinusitis.

The status of the middle turbinate and the risk of sinusitis after endoscopic transnasal sphenoidotomy.
Suslu AE, Savas O, Martin-Bailon M, Ozer S, Onerci M.
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Sidhartha Nagala

Royal Hallamshire Hospital, Sheffield, UK.

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