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S295: TRAP DOOR INFERIOR TURBINATE TRANSPOSITION FOR ENDOSCOPIC MEDIAL MAXILLECTOMY AND SKULL BASE ACCESS
Amreen B Karim; Ivan El-Sayed; University California San Francisco

Introduction: Access to the posterior maxilla, pterygoid fossa, infratemporal fossa, nasopharynx, and clivus is often limited by the inferior turbinate (IT). Complete IT resection increases morbidity, while traditional pre- and post-lacrimal approaches provide limited exposure. We describe a novel “Trap Door” inferior turbinate maneuver, allowing broad exposure while preserving IT function.

Methods: A retrospective review was conducted of patients undergoing endoscopic medial maxillectomy with the Trap Door IT maneuver between 2019–2025 at a tertiary academic center. The anterior IT was detached at the piriform aperture, rotated superiorly to expand the surgical corridor, and replaced at case completion. Data collected included diagnoses, surgical targets, extent of IT preservation, perioperative radiation therapy, complications, and postoperative sinonasal outcomes (SNOT-22).

Results: Twenty-one patients underwent the procedure with a mean follow-up of 827.5 days. Seventeen patients (81.0%) had malignant tumors and five (19.0%) had benign or low-grade lesions. Six (28.6%) received preoperative radiation and twelve (57.1%) postoperative radiation. The IT was preserved in 12 patients (57.1%), partially preserved in 8 (38.1%), and fully resected in 1 (4.8%). Surgical access included the nasopharynx, clivus, infratemporal fossa, retroantral region, and parapharyngeal space. The mean postoperative SNOT-22 score was 51.1. Functional morbidity included nasal obstruction in 9 patients (42.9%) and nasal dryness in 4 (19.0%). One patient (4.8%) died during follow-up; all others remained alive.

Conclusions: The Trap Door IT maneuver provides wide exposure to multiple skull base compartments while preserving nasal physiology in the majority of cases. This technique minimizes morbidity compared to complete IT resection, supports complex oncologic resections, and may reduce long-term sinonasal dysfunction, though radiation history remains a strong determinant of postoperative symptom burden.

 

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