Potential conflict of interest: None provided.
Basal lamella relaxing incision improves endoscopic middle meatal access
Article first published online: 4 OCT 2012
© 2013 ARS-AAOA, LLC
International Forum of Allergy & Rhinology
Volume 3, Issue 3, pages 231–235, March 2013
How to Cite
How to Cite this Article: Basal lamella relaxing incision improves endoscopic middle meatal access. Int Forum Allergy Rhinol, 2013; 3:231–235.,
- Issue published online: 12 MAR 2013
- Article first published online: 4 OCT 2012
- Manuscript Accepted: 3 JUL 2012
- Manuscript Revised: 10 JUN 2012
- Manuscript Received: 8 FEB 2012
- paranasal sinuses;
- nasal sinuses;
- sinuses, turbinates;
- operative procedures
Lateralization of the middle turbinate is a commonly cited factor leading to failure of functional endoscopic sinus surgery (FESS). Inadequate medialization during FESS may require repeat intraoperative attempts, and may lead to destabilization and mucosal trauma. A novel technique is described that increases middle meatal area and provides more definitive medialization at the outset of FESS.
Twenty-nine middle turbinate medializations were prospectively evaluated in 18 consecutive patients undergoing primary ESS. Three intraoperative images of the middle meatus were obtained in the native position, after Freer medialization, and after basal lamella relaxing incision (BLRI). Measurements of middle meatal area were then calculated in a blinded and randomized fashion.
Distances measured from the middle turbinate to the lateral nasal wall for each position ranged from 0 to 8 mm (median = 3.00 mm) for the native position, 0.5 to 10 mm (median = 5.00 mm) for standard Freer medialization, and 3 to 21 mm (median = 10.00 mm) for BLRI. Friedman's analysis of variance (ANOVA) showed that there was significant difference between the 3 measurements, and the post hoc Wilcoxon signed ranks tests showed that BLRI distance (median = 10; 95% confidence interval [CI], 7-11.2) was significantly larger than both standard Freer (median = 5; 95% CI, 4-6.2) and native (median = 3; 95% CI, 2-3) and that standard Freer was significantly larger than native (all p values <0.001).
BLRI is a safe, controlled technique that provides significantly greater medialization of the middle turbinate compared to standard medialization techniques. BLRI significantly enhances the operative space within the middle meatus.