The Transverse Turbinate Line: A Reliable Landmark for the Maxillary Sinus Natural Ostium

Area of Science:

• Otolaryngology
• Anatomical Studies
• Surgical Navigation

Background:

• Accurate localization of the maxillary sinus natural ostium (MSNO) is crucial for successful endoscopic sinus surgery (ESS).
• Current reliance on the maxillary line as the sole landmark can lead to challenges in identifying the MSNO, resulting in common issues like maxillary recirculation during revision ESS.
• The need for an additional, reliable anatomical landmark to improve MSNO identification and surgical outcomes is evident.

Purpose of the Study:

• To introduce and validate a novel anatomical landmark, the transverse turbinate line (TTL), to assist in the precise localization of the MSNO.
• To provide surgeons with a second visual reference point, complementing the existing maxillary line, for improved anterograde surgical access to the MSNO.
• To enhance the accuracy of MSNO identification and potentially reduce long-term surgical failure rates in ESS.

Main Methods:

• A cadaveric anatomical study involving the dissection of 40 sinuses was conducted.
• The transverse turbinate line (TTL) was identified and defined as a 2-millimeter zone.
• The craniocaudal positioning of the MSNO was analyzed in relation to the TTL and the maxillary line.

Main Results:

• The transverse turbinate line (TTL) was consistently found to correspond to the zone between the superior and inferior aspects of the maxillary sinus natural ostium (MSNO).
• This anatomical relationship was observed across the 40 dissected cadaveric sinuses, demonstrating reliability.
• The TTL serves as a dependable second landmark for MSNO localization.

Conclusions:

• The introduction of the transverse turbinate line (TTL) as a second landmark offers a significant advancement in sinonasal surgery.
• This landmark is anticipated to decrease the learning curve for trainees in accessing the MSNO and improve overall surgical precision.
• The use of the TTL is expected to contribute to lower rates of maxillary surgery failure and recirculation in the long term.