Comparison of functional airway and odor results of middle turbinoplasty with medial mucosal flap technique

Objective: Middle turbinate hypertrophy is not a rare cause of nasal obstruction and olfactory disorders. Patients with solid middle turbinate hypertrophy along with other obstructive causes such as septal deviation were examined clinically and radiologically. These patients underwent endoscopic septoplasty and subtotal (transverse) excision of the middle turbinates or medial mucosal flap surgery technique described in this study. Olfactory and obstructive results were compared to investigate the advantage of medial mucosal flap technique of the middle turbinoplasty. Materials and Methods: Thirty-five patients who were diagnosed with solid middle turbinate hypertrophy and septum deviation and planned for surgery following endoscopic examination and paranasal sinus CT between November 2020 and November 2021 at Bezmialem Vakif University, Department of Otorhinolaryngology were included. The patients participating in the study were divided into two groups and middle turbinoplasty (Study group=17) and transverse resection of the middle turbinates (Control group=18). Middle turbinoplasty was performed utilizing a novel surgical medial mucosal flap technique. Approval of the study was obtained from the Bezmialem Vakif University Clinical Research Ethics Committee. Age, gender and patient complaints were recorded as medical data. Acoustic rhinometry, anterior rhinomanometry, peak nasal inspiratory flowmeter test, odor identification test and nbutanol threshold measurement were performed before and three months after the operation. In addition, preoperative and postoperative nasal obstruction and smell sensation levels of the patients were assessed with visual analog scale and nasal obstruction symptom evaluation scale. Preoperative and postoperative results were compared both within and between groups. Results: Of the patients, 16 (45.7%) were male and 19 (54.3%) were female. The age of the patients in the study group was 34.11±12.12, and the patients in the control group were 30.33±10.8 years. There was no statistically significant difference between age and gender (p>0.05). No significant bleeding or major complications were observed after the operation. In the study group operated with the medial mucosal flap technique, less crusting was observed in the middle meatus compared to the control group who underwent transverse resection. In general, between the pre- and postoperative scores in both groups; It showed a strong and significant improvement over time in nasal obstruction symptom evaluation scores, peak nasal inspiratory flowmeter values, visual analog scale respiratory scores, nasal cavity cross-sectional area (MCA) and nasal volume (VOL) values in acoustic rhinometry test, and mean resistance (MR) values in anterior rhinomanometry test (p<.001). Among the visual analog scale odor values, the scores in the study group were higher than in the control group, and there was a statistically significant difference. While a significant improvement was observed in the study group, a decrease was observed in the control group between the pre- and postoperative scores of the odor identification test. While this improvement in identification values was statistically significant in the study group, the decrease in the control group was not significant. There was a decrease in n butanol thresholds in the study group and an increase in the control group. However, these changes were not statistically significant. Conclusion: Our study showed that with the application of both treatment techniques, patients' quality of life improved and nasal congestion decreased. Medial mucosal flap technique is a conservative and effective turbinoplasty technique that can be used in solid hypertrophy of the middle turbinate, which offers advantages in terms of both nasal airway and olfactory results.