HISTOPATHOLOGICAL ANALYSIS OF THE MIDDLE TURBINATE AFTER ETHMOIDECTOMY

A goal in ethmoid sinus surgery is to ventilate the sinuses by complet e removal of all diseased tissue in the ostiomeatal complex. Many surg eons routinely preserve the middle turbinate because they feel it is n ot part of the disease process and its structure is very important for proper nasal physiology. Other surgeons frequently remove such to fac ilitate exposure to the ostiomeatal complex and, more importantly, the y postulate that it is chronically diseased. This study involved 22 ad ult patients with CAT scan Stage I:2, II:2, III:5, and IV:13 sinus dis ease who underwent intranasal ethmoidectomy with resection of the midd le turbinate. Three additional turbinate resections performed for othe r reasons in patients with negative radiological findings served as co ntrols. Histologic findings demonstrated the middle turbinate was chro nically diseased to a similar degree as the ethmoids in all 22 patient s. Respiratory mucosa without significant pathologic change was found in the controls. This suggests resection of the middle turbinate may b e essential, especially in CAT scan Stage III and IV disease. Persiste nt disease in the middle turbinate may enhance the tendency for synech ia formation with the lateral nasal wall and may also account for fail ure to relieve symptoms in some patients. The question of reversibilit y of disease in the middle turbinate following ostiomeatal complex sur gery remains unanswered.