Reconstituting middle turbinate anatomy after pituitary surgery

Pituitary surgery is now increasingly performed as a joint procedure combining the expertise of a neurosurgeon and an otorhinolaryngologist. As endoscopic sinus surgery is currently one of the commonest surgical procedures performed by ear, nose and throat surgeons, familiarity of sphenoid sinus anatomy over several years of training becomes second nature to those with this interest. The endoscopic approach to the pituitary fossa via the sphenoid sinus allows a minimally invasive approach, thus reducing postsurgical morbidity and duration of hospital stay. The surgical approach involves lateralization of the middle turbinate followed by burring away of the face of the sphenoid air cell. Those without experience of sinus surgery may neglect to reconstitute the position of the middle turbinate at completion of surgery. Further mucosal contraction, scarring and synechiae formation will cause spontaneous lateralization of the middle turbinate during the healing period. This may predispose the patient to chronic sinusitis as a consequence of occlusion at the critical osteomeatal complex. The most satisfactory postoperative results are achieved by maintaining patency of the middle meatus. This will allow sinus aeration and drainage, and the delivery of topical medication should this be required. This paper describes a conchopexy suture placed at completion of pituitary fossa surgery. A carefully placed suture will maintain a widely patent middle meatus during the phase of postoperative healing, thus reducing the risk of chronic sinusitis.