Partial Resection Versus Preservation of the Middle Turbinate in Endoscopic Sinus Surgery: A Systematic Review and Meta-Analysis

Background: To compare postoperative outcomes between partial resection and preservation of the middle turbinate (MT) in patients with chronic rhinosinusitis undergoing endoscopic sinus surgery (ESS). Methods: A comprehensive search was undertaken across multiple major bibliographic databases, including PubMed, Scopus, Web of Science, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL). Our outcome assessment measures included postoperative complications such as bleeding, synechia formation, MT lateralization, crustations, CSF leak, orbital injury, middle meatal antrostomy obstruction, frontal recess obstruction, revision surgery rate, smell test scores, and patient-reported outcomes (PROMs). Data were pooled using STATA software as risk ratio, mean difference, or standardized mean difference. Results: Fifteen clinical trials involving 2037 patients were analyzed. Partial MT resection was significantly associated with reduced rates of postoperative synechiae, MT lateralization, middle meatal obstruction, and frontal recess obstruction. Rates of postoperative bleeding, crusting, CSF leak, orbital injury, and revision surgery were comparable between the partial resection and preservation groups. No significant differences were found in olfactory outcomes. While PROMs, nasal obstruction, and headaches improved with partial resection, SNOT scores and nasal discharge remained similar. Conclusions: Partial MT resection demonstrated a safe and effective technique during ESS. Further large-scale RCTs are warranted to confirm and extend these findings.