The importance of the sense of smell and taste to the psychological wellbeing of patients is often underestimated. Imagine if all you could taste was salty, sweet, bitter, and sour and that you could not smell your partner's perfume, aftershave, or pheromones! Smell is a precious sense, and every effort should be made to preserve or improve it (Fig. 12.25). This essentially means total respect of the olfactory mucosa that extends from the cribriform plate to cover almost all the medial side of the middle turbinate, and not only the same area on the septum but usually a little further in-feriorly.

To avoid damaging this mucosa, it helps to give pre-operative oral steroids (unless there are contraindications), especially if there are polyps medial to the middle turbinate visible at endoscopy when the patient is assessed as an outpatient. When polyps re-

Middle Turbinates
Fig. 12.25 A CT scan in a patient who has anosmia after resection of the olfactory mucosa.
Nasal Anosmia
Fig. 12.26 The olfactory cleft has been opened by gently lateralizing the middle turbinate after an ethmoidectomy.
Meatal Stenosis Surgery
Fig. 12.27 Frontal stenosis after this area has been instrumented in the past.

main medial to the middle turbinate at surgery, it is best to perform a thorough ethmoidectomy and then gently lateralize the middle turbinate to open up the olfactory cleft (Fig. 12.26). It is not a problem if the anterior end of the middle turbinate becomes adherent to the lateral wall provided the middle meatal an-trostomy has been extended inferiorly below the inferior limit of the middle turbinate. Under these circumstances, visibility of the frontal recess in outpatients may be limited using a 2.7 mm 0° scope; it can be seen with a 30° scope, although this is rarely necessary. The recovery of mucosa in the olfactory cleft using this technique, even with large polyps in this area, needs to be tried to be believed. The technique also minimizes the risks of adhesions in this area and allows better access to topical nasal steroids. If a patient has hy-posmia or anosmia after surgery and the middle turbi-nate is adherent to the septum, it is worth resecting these and lateralizing the middle turbinate as an elec tive procedure when any mucosal edema has settled down.

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