An Improved Method for Temporary Suture Medialisation of the Middle Turbinates following Endoscopic Sinus Surgery

Abstract

Background: Middle turbinate (MT) lateralisation with adhesion formation (MiTLAF) is a common complication following endoscopic sinus surgery, frequently resulting in surgical failure, persistence of preoperative symptoms, and delayed secondary complications. Packing materials, splints, or spacers reduce the risk of MiTLAF but often result in postoperative nasal obstruction and discomfort, along with reduced access for irrigation. Temporary suture medialisation of the MTs reduces the risk of MiTLAF and prevents the problems encountered with packing, splints, or spacers. However, the techniques described in the literature are technically challenging and often ineffectual.

Methods: We describe a method of suture placement that provides a secure temporary MT medialisation, without the technical challenges of traditional techniques, using a 4-0 Monocryl (Poliglecaprone 25, Ethicon, Somerville, NJ, USA) suture on a 19 mm precision point reverse cutting PS-2 curved needle. We review 25 consecutive patients undergoing sinonasal procedures with our new technique and assess for MiTLAF.

Results: In our cohort, only one patient experienced MiTLAF which was not clinically significant.

Conclusions: Our method is simple, easy to perform, and highly effective and prevents adhesion formation without the need for postoperative splints or packing.

Figure 1

Step 1. A 4-0 Monocryl on a 19 mm precision point reverse cutting PS-2 curved needle is hand-tied at the caudal end of the septum.

Figure 2

Step 2. A series of passes are made through the septum, each around 1cm posterior to the previous one, until the anterior margin of the MT is reached.

Figure 3

Oblique and axial views. Step 3. An initial pass is made incorporating the right MT and the septum alone. The needle tip is then grasped on the left side between the septum and left MT.

Figure 4

Oblique and axial views. Step 4. The needle is reversed and passed through the left MT and septum alone. The needle tip is then grasped on the right side between the septum and right MT and pulled tight (for demonstration purposes, the suture has been drawn loose in this figure and in Figure 5).

Figure 5

Oblique and axial views. Step 5. The suture is then passed anteriorly with 1cm passes.

Figure 6

Oblique and axial views. Step 6. The suture is hand-tied to the original knot and divided.

Figure 7

Middle turbinate suturing technique incorporating septoplasty quilting stitch.