Department of Otolaryngology and Head and Neck Surgery, Istituto Clinico Città Studi, Via Jommelli 17, Milano, 20131, Italy.
Department of Clinical Sciences and Community Health, San Giuseppe Hospital, Università Degli Studi di Milano, Milan, Italy.
Eur Arch Otorhinolaryngol. 2024 Dec;281(12):6187-6199. doi: 10.1007/s00405-024-08825-4. Epub 2024 Jul 11.
Middle turbinate (MT) surgery is extremely common during endoscopic sinus surgery procedures, though no agreement exists on which techniques provide the best outcomes. This PRISMA-compliant systematic review aims to assess which MT surgery technique yields the least postoperative adverse effects and the best objective and subjective outcomes.
A comprehensive search criteria was conducted in multiple databases up to July 3, 2023, to identify studies reporting surgical treatments of the MT. After screening and quality assessment, 14 articles were included for analysis. Data on patients demographics, surgical approaches, postoperative treatment and follow-up, objective and subjective outcomes were extracted and reviewed.
Out of 173 unique papers identified, 14 articles met the inclusion criteria, predominantly randomized controlled trials (n = 9). Antero-inferior middle turbinectomy was the predominant surgical approach. Most studies evaluated results with postoperative endoscopy, a superior outcome was documented in the intervention group (ten out of eleven cases). In four out five studies using the SNOT-22, the treatment group was associated with a statistically significant improvement. Olfactory questionnaires highlighted superior olfactory outcome in two out of three studies. The UPSIT score revealed no significant difference between groups. Objective olfactory assessments favored treatment groups in both studies utilizing olfactometry.
It seems that a partial MT surgical approach consistently yields subjective and objective improvements compared to conservative measures, also suggesting a positive impact on smell function. Despite it appears that better outcomes with fewer complications are consistently achieved with partial techniques, it remains challenging identifying which partial technique surpasses the others, due to significant heterogeneity among the studies.
中鼻甲（MT）手术在鼻内镜鼻窦手术中非常常见，但哪种技术能提供最佳效果尚无共识。本 PRISMA 符合的系统评价旨在评估哪种 MT 手术技术术后不良反应最少，客观和主观效果最好。
我们在多个数据库中进行了全面的搜索，截止到 2023 年 7 月 3 日，以确定报告 MT 手术治疗的研究。经过筛选和质量评估，纳入了 14 篇文章进行分析。提取并回顾了有关患者人口统计学、手术方法、术后治疗和随访、客观和主观结果的数据。
在 173 篇独特的论文中，有 14 篇文章符合纳入标准，主要为随机对照试验（n=9）。前下鼻甲切除术是主要的手术方法。大多数研究都用术后内镜评估结果，干预组记录到更好的结果（11 例中有 10 例）。在使用 SNOT-22 的四项研究中，治疗组与统计学上显著的改善相关。嗅觉问卷在三项研究中有两项表明治疗组嗅觉结果更好。UPSIT 评分显示两组之间无显著差异。在两项使用嗅觉计的研究中，客观嗅觉评估均支持治疗组。
与保守治疗相比，部分 MT 手术方法似乎能持续带来主观和客观的改善，也提示对嗅觉功能有积极影响。尽管部分技术似乎能获得更好的效果和更少的并发症，但由于研究之间存在显著的异质性，仍难以确定哪种部分技术优于其他技术。
