Histopathological Analysis of the Middle Turbinate after Ethmoidectomy

Abstract

A goal in ethmoid sinus surgery is to ventilate the sinuses by complete removal of all diseased tissue in the ostiomeatal complex. Many surgeons routinely preserve the middle turbinate because they feel it is not part of the disease process and its structure is very important for proper nasal physiology. Other surgeons frequently remove such to facilitate exposure to the ostiomeatal complex and, more importantly, they postulate that it is chronically diseased. This study involved 22 adult patients with CAT scan Stage I:2, II:2, III:5, and IV:13 sinus disease who underwent intranasal ethmoidectomy with resection of the middle turbinate. Three additional turbinate resections performed for other reasons in patients with negative radiological findings served as controls. Histologic findings demonstrated the middle turbinate was chronically diseased to a similar degree as the ethmoids in all 22 patients. Respiratory mucosa without significant pathologic change was found in the controls. This suggests resection of the middle turbinate may be essential, especially in CA T scan Stage III and IV disease. Persistent disease in the middle turbinate may enhance the tendency for synechia formation with the lateral nasal wall and may also account for failure to relieve symptoms in some patients. The question of reversibility of disease in the middle turbinate following ostiomeatal complex surgery remains unanswered.