title: A comparison of radiographic evidence of frontal sinusitis in middle-turbinate sacrificing versus middle-turbinate sparing approaches to the sella.
abstract: BACKGROUND
  Initial descriptions of endoscopic approaches to the sella and pituitary involved resecting the middle turbinate (MT) to help improve access and visualization. Modifications of these procedures to preserve the MT have since been described, one rationale being to reduce the incidence of frontal sinusitis. The objective of this study was to establish the incidence of postoperative frontal sinusitis in MT sparing (MTsp) and MT sacrificing (MTsc) approaches to the sella.
  
  
  OBJECTIVE
  A retrospective cohort study that compared radiographic evidence of frontal rhinosinusitis or frontal recess obstruction after skull base surgery in patients who underwent MTsc and MTsp endonasal approaches to the sella.
  
  
  METHODS
  Consecutive retrospective review of pre- and postoperative magnetic resonance imaging from two institutions in geographic proximity but with different approaches to the sella. Mucosal thickening in the frontal sinus was measured and graded by a radiologist blinded to patient cohorts.
  
  
  RESULTS
  Seventy-five patients, based on sample size calculations, were included at each site. Baseline demographics and indications for surgery were not significantly different between the groups. No difference was seen between the groups in the overall grade of radiographic frontal sinusitis seen on postoperative imaging. A total of 8 patients (10%) in the MTsc group had measured mucosal thickening, which was increased from their preoperative scan versus 15 in the MTsp group (20%) (p = 0.10). New mucosal thickening of >1 mm was found in three patients in the MTsc group and eight patients in the MTsp group (p = 0.21); the only patient with postoperative complete frontal sinus opacification was in the MTsp group.
  
  
  CONCLUSIONS
  The choice of MTsc versus MTsp in endonasal endoscopic approach to the sella does not seem to make a difference in the incidence of postoperative radiographic frontal sinusitis.
authors.affiliation: Department of Otolaryngology, Western University, London, Ontario, Canada.
authors.forename: Leigh J
authors.initials: LJ
authors.lastname: Sowerby
authors.forename: Sumeer
authors.initials: S
authors.lastname: Mann
authors.forename: Yves
authors.initials: Y
authors.lastname: Starreveld
authors.forename: Trevor
authors.initials: T
authors.lastname: Kotylak
authors.forename: Brad
authors.initials: B
authors.lastname: Mechor
authors.forename: Erin D
authors.initials: ED
authors.lastname: Wright
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005626:Frontal Sinus / Q000473:pathology; D015522:Frontal Sinusitis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012658:Sella Turcica / Q000601:surgery*; D014420:Turbinates / Q000601:surgery*