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Keywords:

  • rhinosinusitis;
  • chronic rhinosinusitis;
  • sinus surgery;
  • endoscopic sinus surgery;
  • FESS;
  • sinus anatomy;
  • middle turbinate;
  • middle turbinate lateralization

Background

The axillary flap approach (AFA) to the frontal recess improves visualization and clearance while minimizing use of angled endoscopes. However, some argue that it destabilizes the middle turbinate (MT) and increases risk of MT lateralization (MTL). We aimed to establish rates of MTL after AFA, as well as to determine whether other surgical or disease factors affect lateralization.

Methods

This study was a retrospective chart review. Endoscopic postoperative videos between 3 and 9 months (short-term) and greater than 9 months (long-term) were reviewed blind to surgery performed. Presence of MTL, ability to pass an endoscope into the middle meatus, and ability to evaluate the frontal recess were recorded. Surgical characteristics obtained from the chart review included: MT conchopexy, septoplasty, concha bullosa, and primary vs revision surgery. Patient characteristics included age, sex, polyposis, asthma, and smoking. Cases were excluded if the MT was absent.

Results

A total of 124 patients (248 operated sides) were included in the short-term cohort. Similar numbers of primary (52.4%) and revision (47.6%) cases were performed, 42.3% had polyposis, and 38% asthmatics. Overall rate of MTL was 14.5%, with an inability to examine the frontal recess in 12.1%. Suture conchopexy of the MT through the septum did not affect lateralization. Results were statistically similar in the long-term cohort.

Conclusion

The AFA yielded a 14.5% and 17.4% MTL in the short-term and long-term cohorts, respectively. This rate appears consistent with reports in the literature that did not use the axillary flap. No patient or surgical factor was found to affect rates of lateralization.