Middle Turbinate Medialization With Absorbable Packing After Trans-sphenoidal Skull Base Surgery: Outcomes and Significance of a Simple Technique

Abstract

Background

Middle turbinate (MT) medialization after endoscopic skull base surgery (ESBS) allows natural positioning of the turbinate, re-opening of the osteomeatal complex, and potential skull base protection from iatrogenic injury by endonasal device insertion. Our institution routinely preserves and medializes the MTs in ESBS by placing bioabsorbable nasal packing in both middle meatuses.

Objective

The goal of our study was to use postoperative endoscopic MT scoring to objectively assess the efficacy and durability of our simple technique, in which bioabsorbable nasal packing is placed in both middle meatuses to position the MTs against the septum, following trans-sphenoidal skull base surgery.

Methods

A single-center retrospective review was performed of consecutive trans-sphenoidal ESBS patients from 2023 to 2024 to assess postoperative MT positioning. Patients with recorded postoperative nasal endoscopies more than 20 days after surgery were included. Recorded endoscopies were evaluated by 2 independent raters using 2 standardized MT scoring systems assessing station and apposition. An additional subgroup analysis was performed in patients with multiple postoperative endoscopies to assess effect of time on MT position.

Results

Fifty patients (100 turbinates) scored by 2 raters were included for a total of 200 turbinate ratings. One hundred ninety-two turbinates (96%) had station assessed as 1+, signifying medialization, and 176 turbinates (88%) demonstrated direct apposition to the septum. Nasal endoscopies were analyzed 43.5 days (median) after surgery. Cohen's kappa coefficient was 0.90 for station and 0.63 for apposition, signifying substantial inter-rater reliability. Subgroup analysis demonstrated no significant effect of time on turbinate station or apposition.

Conclusions

Our experience with bioabsorbable nasal packing in the middle meatus demonstrates that a simple technique can achieve durable MT medialization in many patients following ESBS. Optimizing MT positioning can improve postoperative sinus function and help protect against inadvertent skull base injuries in ESBS patients.