The middle turbinate is a primary reference in all endoscopic endonasal procedures, and therefore it is important to establish useful and effective criteria to manage this structure. The increase in volume of the middle turbinate due to edema, illness or deformity leads to compression of the middle meatal structures. This also will limit adequate viewing during endonasal observation, and in turn makes for a difficult surgical approach into the meatus, leading to impaired management and adequate eradication of the disease. The pneumatized middle turbinate (concha bullosa) can suffer chronic inflammatory disease and present accumulated secretions inside which lead to the formation of mucoceles, or mucopyoceles that will act like an intranasal sinusitis. This is because the concha bullosa is nothing more than another paranasal sinus with its own drainage site easily visible on a good paranasal sinus CT. This pathology has been found in about 14% of our cases. The objective of the surgery is to marsupialize this “Intranasal sinus”, find the drainage site and make it permeable. In the majority of cases we have found that it drains or opens into the superior meatus. In other cases the outflow tract may be into the bulla or the uncinate process. If the drainage site is not marsupialized, the patient will continue to have symptoms associated to persistent edema in this area. The middle turbinate may have a fragile root and a bulbous body as seen in Fig. 1 A, and in this case the bulbous body compresses the horizontal portion of the uncinate process and will, in turn, block the natural maxillary ostium. The instrumentation of the middle turbinate in this case is very difficult, so it is recommended that one carefully debrides the lateral aspects of the bulbous end of the middle turbinate so as to amplify the area and get more room to work with.
KeywordsEndoscopic Sinus Surgery Uncinate Process Middle Turbinate Middle Meatus Drainage Site
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