Comparative Study Between Crushing Technique and Lateral Laminectomy of Middle Turbinate as Auxiliary Management in Pati
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ORIGINAL ARTICLE
Comparative Study Between Crushing Technique and Lateral Laminectomy of Middle Turbinate as Auxiliary Management in Patients Who Underwent Septoplasty with Concha Bullosa Ravi Kumar Vobilisetty1 • Devendra Tiwari2
Received: 10 September 2020 / Accepted: 12 October 2020 Ó Association of Otolaryngologists of India 2020
Abstract The aim is to compare two commonly performed surgical techniques, lateral resection and crushing for Concha Bullosa (CB) as auxiliary management in patients who underwent septoplasty. In Patients diagnosed with DNS and CB, using endoscopy and Computerized Tomography, NOSE score was calculated. All patients underwent septoplasty and depending upon the surgical method followed for CB, patients allotted in two groups. In group A, crushing of middle turbinate was performed using Blakesley forceps and in group B, lateral resection of CB was done. Postoperative NOSE scores were calculated at 6 months and outcomes were compared. Both the surgical methods were highly effective in the management of CB. All patients had significant improvement in the NOSE score when compared with the preoperative values. Two patients in group B developed synechia between the turbinate and lateral wall. However, the superiority of one method over the other could not be established statistically. CB is a common anomaly in anatomy of nose and paranasal sinus. It frequently coexists with DNS and may cause sinus problems if it is over-pneumatised. In such cases, surgical correction is warranted. Crushing of MT and lateral resection are two commonly performed methods, both are equally effective, but the crushing technique has an advantage of mucosal preservation and less postoperative complications.
& Devendra Tiwari [email protected] 1
Medway Maritime NHS Hospital, Gillingham, Kent ME7 5NY, UK
2
Mahatma Gandhi Medical College and Research Institute, Pillyarkuppam, Pondicherry, India
Keywords Concha bullosa Lateral resection Crushing technique NOSE score Septoplasty
Introduction Concha bullosa (CB), pneumatization of the middle turbinate (MT), is one of the most common anatomical variants associated with the nose and paranasal sinus. The incidence of this sinonasal anatomy variation is reported to be between 14 and 53% [1]. Though it is mostly asymptomatic, it can cause serious problems in the case of overpneumatization. Infection from the ethmoid and frontal sinus can involve the CB, resulting in mucocele formation [2] The CB may be so enlarged that it can fill the gap between the septum and lateral wall, creating mucosal contact and narrowing the middle meatus resulting in obstruction of sinus drainage, leading to sinusitis [3]. Controversies exist between authors regarding the association of CB with Deviated Nasal Septum [4]. However, some authors have demonstrated a strong relationship between the presence of large CB and contralateral DNS [1, 5]. There are various methods reported to correct the anatomical defect surgically such as partial resection of the lateral part of the middle
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