Anatomical Changes After Endoscopic Sinus Surgery in Patients with Chronic Rhinosinusitis

Background: Changes in the bony structures of the nose and sinuses such as the medialization of the lamina papyracea and enophthalmos have been reported after sinus surgery. Evidence for the persistence of inferior turbinate (IT) position after IT outfracture is lacking. Objectives: To evaluate for anatomical changes of the IT, lamina and the globes, after sinus surgery and the durability of inferior turbinate outfracture. Methods: A total of forty-four patients who underwent revision endoscopic sinus surgery that included complete ethmoidectomy and IT outfracture were matched. Pre- and post-operative computed tomography scans (CT) were used for evaluating and measuring the anatomical changes in different planes. The posterior globe position in the axial plane, the distance between the lamina papyracea (IOD_Axial, IOD_Coronal) in coronal and axial planes and the distance from the IT to the septum (IT_M) and the lateral nasal wall (IT_L) were measured. Results: There were 16 women and 28 men. Mean follow-up time (time from procedure to post-operative CT scan) was 38.9 ± 20.1 months. Statistically significant lateralization of the IT was observed with IT_L (95%CI 1.1 mm to 1.5 mm p < 0.0001) and IT_M (95%CI -1.5 mm to -1.1 mm; p < 0.0001). No statistically significant differences were seen in IOD_Axial and IOD_Coronal in pre-op and post-op CT scans. (p = 0.23 and p = 0.7, respectively) and no significant displacement of the globe in antero-posterior direction was seen (p = 0.915). Conclusions: IT outfracture appears to have a durable effect on IT position that lasts for several years. Ethmoidectomy did not cause the medialization of the laminae nor altered the position of the globes.