No relevant disclosures Introduction Middle turbinate lateralization Synechiae

No relevant disclosures

Introduction Middle turbinate lateralization Synechiae formation Prevention: ü Nasal packing or stent ü Partial/ total middle turbinectomy ü Controlled synechia

Middle turbinate(MT) suturing medialization üOriginally in 1996 in America üMedialize and stabilize the MT üDecreased rate of synechia formation Arch Otolaryngol Head Neck Surg 1996; 122(8): 869 -872 J Otolaryngol 2000; 29: 144– 147. Laryngoscope 2015; 125: 33– 35 Glob J Oto 2018; 16: 555939

Olfactory neuroepithilium üNot entirely clear üOlfactory cleft üSeptum, anterior and middle portions of the MT Eur Arch Otorhinolaryngol 2009; 266(11): 1675– 1680 Laryngoscope 2000; 110(3 Pt 1): 417421 Arch Otolaryngol Head Neck Surg 1998; 124(08): 861– 866

Effect on Olfaction? üLess air flow into olfactory cleft üInjury to olfactory mucosa

Purpose Will MT suture during FESS impair patients’ olfaction?

Materials A retrospective, controlled study ü 1163 cases in CMUH üFrom Oct, 2009~July, 2018 üReceived FESS

Materials Inclusion üAge >18 year-old; FESS for CRS üPreop / post-op 3 months üObjective: 1) Sniffin’ Sticks smell identification test (score: 0~12) 2) Mucociliary clearance function(saccharine transit time , STT) üSubjective: 1) 22 -item Sino-Nasal Outcome Test (SNOT-22) 2) Self perception of nasal obstruction (R/ L; score: 1~5: mild to severe)

Materials Exclusion ü<18 year-old üBenign/malignant neoplasm üCongenital/ traumatic anosmia üIncomplete data üLost to follow-up

Materials 279 cases recruited • Study group, n=188 üUse PDS® II (polydioxanone)4 -0 Suture MT suture üRemoved in postop 1 month • Control group, n= 91 üNo MT suture üOnly nasal packing(vaseline gauze or nasopore)

Methods Independent variable ü MT suture or not suture Dependent variables üChange of smell test score (Sniffin’ Sticks test) üChange of SNOT-22 üChange of self perception of nasal obstruction(R/ L; score: 1~5) üChange of mucociliary clearance function(MCC)(saccharine transit time , STT)

Methods Control variables üSex üAge üCigarette smoking üComorbidities: DNS, asthma, allergic rhinitis, atopic dermatitis üLaterality: unilateral, bilateral sides üLund-Mackay CT score • Independent T-test, p value <0. 05 significance

Results More bilateral CRS diseases in control group

Discussion Friedman et al. (1999) No detectable adverse effect on olfaction (Microdebrider assisted synechia formation between septum and MT) Laryngoscope 1999; 109: 1442 -1445 Jay et al. (2011) MT suture conchopexy during ESS does not impair olfaction Am J Rhinol Allergy 2011; 25, 125 -127 üCompare UPSIT* score at pre-op and post-op üNo control group *UPSIT = University of Pennsylvania Smell Identification Test

Discussion Our study • The first study üCompare study and control group • Improved after FESS in these two groups üSmell test üMCC üSNOT-22 üSelf perception of nasal obstruction

Discussion • Compare study group and control group üNo significant difference on change of smell test and SNOT -22 score MT suture medialization does not impair the patient’s olfaction.

Conclusion • Middle turbinate suturing medialization during FESS üAn effective, reliable method for preventing lateralization of the MT and synechiae formation üMT-sparing üNot impair olfactory function

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