A comparison of two sphenoidotomy approaches using a novel computerized tomography grading system

Area of Science:

• Otolaryngology
• Endoscopic Sinus Surgery
• Radiology

Background:

• Endoscopic sphenoid sinus surgery carries risks.
• Surgical techniques depend on superior turbinate attachment to the sphenoid face.
• A novel CT grading system is introduced to assess this attachment.

Purpose of the Study:

• To develop and validate a CT grading system for superior turbinate attachment.
• To correlate this grading system with surgical approach selection.
• To recommend a safer endoscopic sphenoid sinus entry method.

Main Methods:

• A grading system (Types A, B, C, D) was developed for superior turbinate attachment to the sphenoid face.
• 53 patients were analyzed, correlating attachment type with surgical approach (superior turbinate intact vs. resection).
• Statistical analysis (Spearman correlation) was performed.

Main Results:

• Incidence of attachments: Type A (40%), Type B (41%), Type C (18%), Type D (1%).
• Superior turbinate resection (STR) was used in 44% of cases, superior turbinate intact (STI) in 56%.
• Closer attachment to the orbit significantly increased likelihood of STR (p < 0.001).

Conclusions:

• Preoperative evaluation of superior turbinate attachment is crucial for safe sphenoid sinus entry.
• The novel CT grading system aids in selecting the optimal surgical approach.
• This systematic approach enhances endoscopic sinus surgery safety.