Comment on the Management of the Middle and Superior Turbinates

One of the main differences between this and other texts is our concern for the sense of smell and our respect for the turbinate and therefore olfactory tissue. Some authors have advocated resection of the middle turbinate to help access and with the aim of reducing the incidence of adhesions. We do not do this as we try to preserve all the olfactory mucosa on the medial surface of the ethmoturbinals and the septum.

The patient who has had anosmia or severe hy-posmia might not "miss" their sense of smell after surgery as it was poor in the first place. This has led surgeons to become complacent about the sense of smell, particularly in those with late-onset asthma and polyps medial to the middle turbinate, where the results of surgery have been mixed (70% with hy-

posmia are improved but this rarely lasts for longer than 6 months even in the presence of continued medical treatment). However, if you do restore patients' sense of smell their quality of life is much improved and they are extremely grateful. By preserving "all" the mucosa in the olfactory area on the septum and the turbinates, as well as opening the olfactory cleft, this can be done.

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