{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T14:30:06Z","timestamp":1777386606979,"version":"3.51.4"},"reference-count":14,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2020,6,19]],"date-time":"2020-06-19T00:00:00Z","timestamp":1592524800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Rhinol\ufffdAllergy"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Inadvertent intracranial injury from nasogastric tube (NGT) placement is a described and potentially fatal complication following endoscopic transsphenoidal hypophysectomy (TSH). This cadaver study assessed the role of middle turbinate (MT) preservation and medialization in preventing accidental skull base injury from NGT insertion after TSH. Methods: Standard approach for TSH was performed on 3 human cadavers. MTs were placed into neutral position (MTN), then medialized via suture pexy to the septum (MTP), and subsequently resected (MTR). After each stage, 3 blinded individuals passed a 10\u2009F Dobhoff and a 16\u2009F NGT on each side of each cadaver (5 passes per side). Using endoscopic visualization, each pass was scored by a blinded reviewer based on the first contact point of the tube (0\u2009=\u2009nasopharynx, 1\u2009=\u2009inferior sphenoid face, 2\u2009=\u2009sphenoid sinus), with higher scores suggestive of increased risk of intracranial injury. Results: There were 270 Dobhoff and 270 NGT passes scored. Data was divided into 3 groups based on presence and position of the MT. Significant differences were demonstrated between all three groups [one-way ANOVA: Dobhoff F(2,267)\u2009=\u20096.981, p\u2009=\u20090.001], [NGT F(2,267)\u2009=\u200917.582, p\u2009&lt;\u20090.001]. There were significant differences between means for MTN versus MTP groups [Dobhoff (0.43 vs 0.22, p\u2009=\u20090.007), NGT (0.73 vs 0.28, p\u2009&lt;\u20090.001)] and MTP versus MTR groups [Dobhoff (0.22 vs 0.55, p\u2009&lt;\u20090.001), NGT (0.28 vs 0.81, p\u2009&lt;\u20090.001)], indicating that the presence and position of the MT can significantly affect the accessibility of the sphenoid sinus interior after TSH. There was a trend toward lower means in the MTN group compared to the MTR group. Conclusion: MT preservation and deliberate medialization against the septum may reduce risk of inadvertent intracranial NGT injury in postop TSH patients. This simple maneuver should be considered in all routine TSH procedures.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1945892420933173","type":"journal-article","created":{"date-parts":[[2020,6,19]],"date-time":"2020-06-19T07:15:56Z","timestamp":1592550956000},"page":"59-63","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":7,"title":["Using the Middle Turbinate to Protect the Skull Base in Endoscopic Transsphenoidal Surgery: A Cadaver Study"],"prefix":"10.1177","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6172-6508","authenticated-orcid":false,"given":"Janki","family":"Shah","sequence":"first","affiliation":[{"name":"Section of Rhinology, Sinus, and Skull Base Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2315-9930","authenticated-orcid":false,"given":"Dennis","family":"Tang","sequence":"additional","affiliation":[{"name":"Section of Rhinology, Sinus, and Skull Base Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9238-6569","authenticated-orcid":false,"given":"Kevin","family":"Grafmiller","sequence":"additional","affiliation":[{"name":"Section of Rhinology, Sinus, and Skull Base Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zachary J.","family":"Cappello","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, Charlotte Eye, Ear, Nose and Throat, Charlotte, North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher","family":"Roxbury","sequence":"additional","affiliation":[{"name":"Rhinology and Endoscopic Skull Base Surgery, Department of Surgery, Section of Otolaryngology\u2014Head and Neck Surgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raj","family":"Sindwani","sequence":"additional","affiliation":[{"name":"Section of Rhinology, Sinus, and Skull Base Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio"},{"name":"Minimally Invasive Cranial Base and Pituitary Surgery, Rosa Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2020,6,19]]},"reference":[{"key":"bibr1-1945892420933173","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinimag.2011.12.020"},{"key":"bibr2-1945892420933173","doi-asserted-by":"publisher","DOI":"10.1097\/00000446-200208000-00033"},{"key":"bibr3-1945892420933173","doi-asserted-by":"crossref","unstructured":"Lo JO, Wu V, Reh D, Nadig, S, and Wax, M. Diagnosis and management of a misplaced nasogastric tube into the pulmonary pleura.\n                      Arch Otolaryngol Head Neck Surg\n                      . 2008;134:547\u2013550.","DOI":"10.1001\/archotol.134.5.547"},{"key":"bibr4-1945892420933173","doi-asserted-by":"publisher","DOI":"10.1177\/000348948109000511"},{"key":"bibr5-1945892420933173","doi-asserted-by":"publisher","DOI":"10.1067\/moe.2000.110032"},{"key":"bibr6-1945892420933173","first-page":"1140","volume":"3","author":"Gill K","year":"2016","journal-title":"Ann Otolaryngol Rhinol"},{"key":"bibr7-1945892420933173","doi-asserted-by":"publisher","DOI":"10.1016\/S0736-4679(96)00356-3"},{"key":"bibr8-1945892420933173","doi-asserted-by":"crossref","unstructured":"Paul M, Dueck M, Kampe S, Petzke F, and Ladra, A. Intracranial placement of a nasotracheal tube after transnasal trans-sphenoidal surgery.\n                      Br J Anaesth.\n                      2003;91:601\u2013604.","DOI":"10.1093\/bja\/aeg203"},{"key":"bibr9-1945892420933173","unstructured":"Martinelle F, Montaut J, Hazeaux C. P\u00e9n\u00e9tration intracranienne d\u2019une sonde gastrique \u00e0 travers une dehiscence traumatique de la lame cribl\u0131e.\n                      Cahiers d\u2019Anesth\u0131siologie\n                      . 1974;22:345."},{"key":"bibr10-1945892420933173","doi-asserted-by":"crossref","unstructured":"Genu PR, De Oliveira DM, De Holanda Vasconcellos RJ, Viana Bessa Noguiera R, and Cavalcanti do Egito Vasconcelos B. Inadvertent intracranial placement of a nasogastric tube in a patient with severe craniofacial trauma: a case report.\n                      J Oral Maxillofac Surg\n                      . 2004;62:1435\u20131438.","DOI":"10.1016\/j.joms.2004.07.005"},{"key":"bibr11-1945892420933173","doi-asserted-by":"crossref","unstructured":"Fletcher SA, Henderson LT, Miner ME, and Jones JM. The successful surgical removal of intracranical nasogastric tubes.\n                      J Trauma\n                      . 1987;27:948\u2013952.","DOI":"10.1097\/00005373-198708000-00017"},{"key":"bibr12-1945892420933173","doi-asserted-by":"publisher","DOI":"10.1055\/s-0036-1584077"},{"key":"bibr13-1945892420933173","doi-asserted-by":"publisher","DOI":"10.1177\/000348949810700806"},{"key":"bibr14-1945892420933173","doi-asserted-by":"crossref","unstructured":"Hanna AS, Grindle CR, Patel AA, Rosen MR, and Evans JJ. Inadvertent inser-tion of nasogastric tube into the brain stem and spinal cord after endoscopic skull base surgery.\n                      Am J Otolaryngol Head Neck Med Surg\n                      . 2012;33:178\u2013180.","DOI":"10.1016\/j.amjoto.2011.04.001"}],"container-title":["American Journal of Rhinology &amp; Allergy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1945892420933173","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/1945892420933173","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1945892420933173","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T09:36:42Z","timestamp":1777369002000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/1945892420933173"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6,19]]},"references-count":14,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,1]]}},"alternative-id":["10.1177\/1945892420933173"],"URL":"https:\/\/doi.org\/10.1177\/1945892420933173","relation":{},"ISSN":["1945-8924","1945-8932"],"issn-type":[{"value":"1945-8924","type":"print"},{"value":"1945-8932","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,6,19]]}}}