Submucous inferior turbinotomy cooperating with combined antrostomies for endonasal eradication of severe and intractable sinusitis

• Published in: Auris, nasus, larynx Vol. 36; no. 2; pp. 162 - 167
• Main Authors: Hinohira, Yasuyuki, Hyodo, Masamitsu, Gyo, Kiyofumi
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ireland Ltd 01.04.2009
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Antrochoanal polyps; Chronic Disease; Combined Modality Therapy; Endoscopic sinus surgery; Endoscopy; Female; Follow-Up Studies; Fungal ball sinusitis; Humans; Inferior turbinate; Male; Maxillary Sinus - diagnostic imaging; Maxillary Sinus - surgery; Maxillary Sinusitis - diagnostic imaging; Maxillary Sinusitis - surgery; Middle Aged; Mycoses - diagnostic imaging; Mycoses - surgery; Nasal Mucosa - diagnostic imaging; Nasal Mucosa - surgery; Nasal Polyps - diagnostic imaging; Nasal Polyps - surgery; Otolaryngology; Postoperative Complications - etiology; Submucous turbinotomy; Tomography, X-Ray Computed; Turbinates - diagnostic imaging; Turbinates - surgery; Young Adult; Antrochoanal polyps; Endoscopic sinus surgery; Inferior turbinate; Fungal ball sinusitis; Submucous turbinotomy
• ISSN: 0385-8146; 1879-1476; 1879-1476
• DOI: 10.1016/j.anl.2008.03.013

This paper aims to prove the usefulness of submucous inferior turbinotomy cooperating with the combined middle and the inferior antrostomies in endoscopic endonasal sinus surgery (ESS), enabling the eradication of severe maxillary sinusitis without extranasal approaches. The long-term surgical outcomes of 22 adult patients are presented together with details of this procedure. Subjects comprised 22 adult patients with severe unilateral maxillary sinusitis, showing total opacification on computed tomography and failure of medical treatments preoperatively. Patients who could be managed using conventional ESS methods were excluded. Endoscopic submucous resection of the inferior turbinate bone including the uncinate process was first performed. The procedure aimed to make both the middle and the inferior nasal meatus wide enough to eradicate the sinus disease, cooperating with combined antrostomies. Pathology comprised multiple massive polyposis including antrochoanal polyps in 6 and fungal ball in 16 patients. Neither surgical complications nor recurrent disease was seen postoperatively in any patient. Postoperative endoscopic management via both openings was easy and facilitated the restoration of mucosal lining in the sinus. We proved our new surgical procedure was useful in ESS without any extranasal approaches, although applied to unilateral lesions in the current study. Postoperative management via the middle and the inferior meatal openings helped to facilitate postoperative mucosal healing.