Middle turbinate manipulation and postoperative sinus obstruction after endoscopic endonasal skull-base surgery

Inadvertent lateralization of the middle turbinate (MT) after endoscopic sinus surgery (ESS) is cited as a common complication that results in both outflow tract obstruction and recurrent symptoms. In endoscopic endonasal skull-base surgery, the MT is frequently lateralized during the parasagittal approach. Little is known about whether this strategy has unintended consequences on the adjacent paranasal sinuses. Intentional lateralization vs surgical resection of the MT were compared for radiographic evidence of sinus obstruction in this patient population.

A retrospective evaluation was conducted of pre- and postoperative Lund-MacKay (LM) scores in patients who underwent an endoscopic endonasal approach (EEA) for resection of a pituitary tumor or craniopharyngioma (transsellar or suprasellar approach) between 2012 and 2014. Side-specific LM scores were calculated at 0-3 months, 3-6 months, and >6 months. MT lateralization vs resection sides were compared.

Of the cases reviewed, 122 met the inclusion criteria. There were no statistically significant differences in LM scores of the adjacent paranasal sinuses between resected MTs as compared with surgically lateralized MTs at 3-6 months or >6 months (p = 0.551) postoperatively. Time-point of assessment was statistically significant with regard to the outcome of LM = 0 (p < 0.001), with earlier postoperative imaging correlating with higher LM scores.

Unlike after ESS, MT lateralization does not appear to be correlated with higher LM scores after EEA. Postoperative radiographic sinus outflow obstruction was similar in patients at all measured intervals despite differences in technical management of the MT.