title: The effect of middle turbinate resection on topical drug distribution into the paranasal sinuses.
abstract: During sinus surgery, partial or complete resection of the middle turbinate (MT) is sometimes necessary because of polypoid changes or demineralization. Topical drug delivery to the paranasal sinuses is an integral component in managing chronic rhinosinusitis (CRS) with and without nasal polyposis. The purpose of this study was to examine the role of the MT and MT resection in topical drug distribution into the sinuses via nebulization. We report on a novel technique of quantitatively evaluating the delivery of nebulized dye in cadavers.
  
  
  
  Endoscopic sinus surgery was performed on 5 fresh cadavers. Complementary colored dyes mixed with saline were successively nebulized using the following protocol: (1) fluorescein prior to MT resection; (2) brilliant green following partial MT resection; and (3) methylene blue following total MT resection. Photodocumentation of the sinuses was performed following each nebulization and standardized photoanalysis was performed.
  
  
  
  Successive nebulizations with fluorescein, brilliant green, and methylene blue produced a complementary staining pattern that provided an easy side-by-side analysis of the extent of mucosal staining. Dye delivery to the frontal and sphenoid sinuses significantly increased following partial resection of the MT (p = 0.013 and p = 0.0027, respectively) and complete resection of the MT (p = 0.027 and p = 0.027, respectively). Following complete MTR, dye delivery to the maxillary sinus significantly increased compared to baseline (MT intact) (p = 0.0027).
  
  
  
  Resection of the MT appears to have a significant effect on nebulized drug delivery into the frontal, maxillary, and sphenoid sinuses. Future prospective studies will help delineate the clinical relevance of this effect.
authors.affiliation: Head and Neck Institute, Section of Rhinology, Sinus, and Skull Base Surgery, Cleveland Clinic Foundation, Cleveland, OH.
authors.forename: Ashleigh A
authors.initials: AA
authors.lastname: Halderman
authors.affiliation: Department of Otolaryngology, Mayo Clinic, Rochester, MN.
authors.forename: Janalee
authors.initials: J
authors.lastname: Stokken
authors.affiliation: Head and Neck Institute, Section of Rhinology, Sinus, and Skull Base Surgery, Cleveland Clinic Foundation, Cleveland, OH. sindwar@ccf.org.
authors.forename: Raj
authors.initials: R
authors.lastname: Sindwani
mesh_terms: D000281:Administration, Intranasal; D004396:Coloring Agents / Q000008:administration & dosage / Q000493:pharmacokinetics*; D004724:Endoscopy; D019793:Fluorescein / Q000008:administration & dosage / Q000493:pharmacokinetics; D006801:Humans; D008751:Methylene Blue / Q000008:administration & dosage / Q000493:pharmacokinetics; D009330:Nebulizers and Vaporizers; D010256:Paranasal Sinuses / Q000378:metabolism*; D000644:Quaternary Ammonium Compounds / Q000008:administration & dosage / Q000493:pharmacokinetics; D014420:Turbinates / Q000601:surgery*
chemical_list: D004396:Coloring Agents; D000644:Quaternary Ammonium Compounds; C006798:brilliant green; D008751:Methylene Blue; D019793:Fluorescein
keywords: chronic rhinosinusitis; endoscopic sinus surgery; nasal polyposis; topical medical therapy