Avoiding Skull Base Injury During Nasal Surgery: CT-Guided Assessment of the Middle Turbinates, Septum, and Skull Base

Background: The present study established clear anatomic relationships between the middle turbinate, septum, and cribriform plate to provide key landmarks by which to avoid cribriform plate injury during septoplasty and/or middle turbinate surgery. Methods: A retrospective chart review of patients older than or equal to 17 years of age who underwent CT sinus imaging was conducted. Patients with a history of facial trauma, prior septorhinoplasty or sinus surgery, and patients with craniofacial syndromes were excluded. Results: One hundred fifty patients met inclusion criteria. Mean patient age was 46.8 ± 24 years (58% female, 42% male). Average length of the cribriform plate was 29.5 ± 4.1 mm and average length of the superior middle turbinate origin was 38.4 ± 4.4 mm. All patients had middle turbinate attachments to the cribriform plate, with the middle turbinate starting an average of 5.8 ± 1.9 mm posterior to the anterior origin of the cribriform plate and spanning 37 ± 6% of the total length of the cribriform plate. The middle turbinate extended posterior to the cribriform plate in all patients. Conclusions: The authors clearly define the anatomic dimensions of the structures adjacent to the cribriform plate using CT-guided measurements. The authors confirm direct connection of the middle turbinate to the cribriform plate in all cases, with a significant portion of the middle turbinate arising from the cribriform plate. Anatomic knowledge of these structures may guide the plastic surgeon to avoid unfavorable fracture patterns and anterior skull base injury during middle turbinate manipulation and septoplasty.