Nasal turbinate resection for relief of nasal obstruction

Prelacrimal approach vs conventional surgery for inverted papilloma in the maxillary sinus

BACKGROUND

The prelacrimal approach, termed endoscopic modified medial maxillectomy (EMMM), has recently been applied for treatment of inverted papilloma (IP) in the maxillary sinus. EMMM provides wider access to the maxillary sinus while preserving the inferior turbinate and nasolacrimal duct.

METHODS

We reviewed patients with IP in the maxillary sinus to compare the surgical results obtained by conventional surgery (ie, endoscopic maxillary sinus antrostomy or in combination with the Caldwell-Luc approach) with those obtained by EMMM.

RESULTS

All patients had a T3 on the Krouse staging system, and the average follow-up time was 46.0 months. Of the 18 patients in the conventional group, recurrence was seen in 3 patients (16.6%). No recurrence was seen in the 27 patients who showed preservation of the inferior turbinate and nasolacrimal duct, and no complications occurred in the EMMM group.

CONCLUSIONS

EMMM is an effective surgical approach that reduces recurrence with fewer complications.

Submucosal Inferior Turbinectomy to Widen the Surgical Corridor for Endoscopic Endonasal Skull Base Surgery

The nasal cavity is the exclusive surgical corridor for endoscopic endonasal surgery; however, it is sometimes too narrow to allow extensive surgical maneuvering. Here we show the technique of submucosal inferior turbinectomy (SIT) to widen this surgical corridor. Its effectiveness is evaluated quantitatively by comparing pre- and intraoperative magnetic resonance images. Between March 2015 and October 2018, we performed endoscopic endonasal resection of 57 skull base tumors with 3T intraoperative magnetic resonance imaging (iMRI). Among these resections, cases with previous endonasal surgery and cases for which the iMRI did not cover the entire nasal cavity were excluded. Finally, six cases with and 19 cases without SIT were included in the subsequent retrospective analysis. We measured the dimensions of the narrowest area in inferior nasal cavity on pre- and intraoperative coronal plane gadolinium (Gd)-enhanced T1-weighted MR images using dedicated software, and compared them. The incidence rates of postoperative nasal complaints at outpatient clinics were also compared. Considerable widening of the inferior nasal cavity could be achieved with the SIT, which was statistically significant compared with those without the SIT (111.1 ± 56.5% vs. 39.4 ± 59.4%, respectively; P = 0.0093). In terms of the incidence rate of postoperative nasal complaints at 6 months, there was no statistical difference between the groups (33.3% vs. 15.8%, respectively; P = 0.35). SIT is effective for widening the surgical corridor while keeping nasal function and is especially helpful for lower clivus and laterally extended skull base lesions.

Physiological changes in the size of the septal swell body correlate with changes in inferior turbinate size

OBJECTIVE

The nasal septal swell body is a normal anatomical structure located in the superior nasal septum anterior to the middle turbinate. However, the impact of the septal swell body in nasal breathing during normal function and disease remains unclear. This study aimed to establish that the septal swell body varies in size over time and correlates this with the natural variation of the inferior turbinates.

METHOD

Consecutive patients who underwent at least two computed tomography scans were identified. The width and height of the septal swell body and the inferior turbinates was recorded. A correlation between the difference in septal swell body and turbinates between the two scans was performed using a Pearson's coefficient.

RESULTS

A total of 34 patients (53 per cent female with a mean age of 58.3 ± 20.2 years) were included. The mean and mean difference in septal swell body width between scans for the same patient was 1.57 ± 1.00 mm. The mean difference in turbinate width between scans was 2.23 ± 2.52 mm. A statistically significant correlation was identified between the difference in septal swell body and total turbinate width (r = 0.35, p = 0.04).

CONCLUSION

The septal swell body is a dynamic structure that varies in width over time in close correlation to the inferior turbinates. Further research is required to quantify its relevance as a surgical area of interest.

Evaluation of the effect of inferior turbinate outfracture on nasolacrimal transit time by saccharin test

AIM

To evaluate the effect of inferior turbinate outfracture on nasolacrimal transit time by saccharin test.

MATERIALS AND METHODS

Twenty patients who underwent septoplasty + unilateral radiofrequency ablation and outfracture of inferior turbinate were enrolled into study. They had no complaints about their eyes and denied previous ocular surgery. Their nasolacrimal saccharin transit times (NSTTs) were estimated preoperatively and postoperatively in the 1st and 2nd months. The non-fractured side eye was measured only once preoperatively. The fractured-side eye was measured three times. These times were compared statistically.

RESULTS

There were 8 men and 12 women. Mean age was 29.04. Killian incision was used in 14 and hemitransfixion incision was used in 6 patients. Median NSTT was 484, 461, 490 and 446 s for the non-fracture side, preoperatively and postoperatively in the 1st and 2nd months, respectively. There was no statistically significant difference between the two eyes preoperatively, and in the fractured side preoperatively and postoperatively in the 2nd month. There were significant differences between median NSTT in postoperative 1st month and median NSTT in the preoperative measure, and between postoperative 1st and 2nd months (p < 0.05). Median NSST in the 1st month was longer than the others.

CONCLUSION

Outfracture of inferior turbinate had no permanent effect on NSTT 2 months after surgery in patients that had a healthy nasolacrimal system.

The Efficacy of Turbinate Surgery for the Relief of Nasal Obstruction

To study the role of turbinate surgery 60 consecutive patients complaining of nasal airway obstruction were evaluated. All patients had a deviated nasal septum and turbinate hypertrophy and had received medical therapy of at least 8 weeks duration. Plain x-rays or computerized tomography scans of the paranasal sinuses excluded sinusitis. Each patient was randomized into one of three groups. Group I underwent septoplasty for correction of the deviated nasal septum. Group II underwent bilateral anterior turbinectomy, and Group III underwent both septoplasty and bilateral anterior turbinectomy. All patients were evaluated preoperatively and on at least one postoperative visit for their subjective perception of improvement or worsening of nasal obstruction. Likewise, all patients underwent anterior rhinomanometry preoperatively and postoperatively. The data revealed no significant difference in reduction of the nasal airway resistance as measured by rhinomanometry for Groups I and II. The patients’ own perceptions of improvement, however, were augmented when turbinectomy was performed (Groups II and III). We conclude that anterior turbinectomy is a useful operation in alleviating the sense of nasal obstruction in patients with hypertrophied inferior turbinates.

Atrophic Rhinitis: A Review of 242 Cases

Atrophic rhinitis is a debilitating nasal mucosal disease of unknown etiology. It is characterized by progressive nasal mucosal atrophy, nasal crusting, fetor, and enlargement of the nasal space with paradoxical nasal congestion. Primary atrophic rhinitis has decreased markedly in incidence in the last century. This probably relates to the increased use of antibiotics for chronic nasal infection. Secondary atrophic rhinitis resulting from trauma, surgery, granulomatous diseases, infection, and radiation exposure accounts for the majority of cases encountered by the rhinologist today. Excessive turbinate surgery has been both acquitted and accused in the literature as an etiology for secondary atrophic rhinitis. We saw 242 patients with the diagnosis of atrophic rhinitis between 1982 and 1999. The diagnosis was confirmed by physical examination, biopsy, and imaging studies. Patients were diagnosed with primary atrophic rhinitis if their condition developed in a previously healthy nose and secondary atrophic rhinitis if their condition developed after sinonasal surgery, trauma, or chronic granulomatous disease. Prevention and treatment of the disease is discussed.

Impact of Middle versus Inferior Total Turbinectomy on Nasal Aerodynamics

OBJECTIVES

This computational study aims to (1) use virtual surgery to theoretically investigate the maximum possible change in nasal aerodynamics after turbinate surgery, (2) quantify the relative contributions of the middle and inferior turbinates to nasal resistance and air conditioning, and (3) quantify to what extent total turbinectomy impairs the nasal air-conditioning capacity.

STUDY DESIGN

Virtual surgery and computational fluid dynamics.

SETTING

Academic tertiary medical center.

SUBJECTS AND METHODS

Ten patients with inferior turbinate hypertrophy were studied. Three-dimensional models of their nasal anatomies were built according to presurgery computed tomography scans. Virtual surgery was applied to create models representing either total inferior turbinectomy (TIT) or total middle turbinectomy (TMT). Airflow, heat transfer, and humidity transport were simulated at a steady-state inhalation rate of 15 L/min. The surface area stimulated by mucosal cooling was defined as the area where heat fluxes exceed 50 W/m(2).

RESULTS

In both virtual total turbinectomy models, nasal resistance decreased and airflow increased. However, the surface area where heat fluxes exceed 50 W/m(2) either decreased (TIT) or did not change significantly (TMT), suggesting that total turbinectomy may reduce the stimulation of cold receptors by inspired air. Nasal heating and humidification efficiencies decreased significantly after both TIT and TMT. All changes were greater in the TIT models than in the TMT models.

CONCLUSION

TIT yields greater increases in nasal airflow but also impairs the nasal air-conditioning capacity to a greater extent than TMT. Radical resection of the turbinates may decrease the surface area stimulated by mucosal cooling.

Does septoplasty change the dimensions of compensatory hypertrophy of the middle turbinate?

OBJECTIVE

To measure the dimensions of compensatory hypertrophy of the middle turbinate in patients with nasal septal deviation, before and after septoplasty.

METHODS

The mucosal and bony structures of the middle turbinate and the angle of the septum were measured using radiological analysis before septoplasty and at least one year after septoplasty. All pre- and post-operative measurements of the middle turbinate were compared using the paired sample t-test and Wilcoxon rank sum test.

RESULTS

The dimensions of bony and mucosal components of the middle turbinate on concave and convex sides of the septum were not significantly changed by septoplasty. There was a significant negative correlation after septoplasty between the angle of the septum and the middle turbinate total area on the deviated side (p = 0.033).

CONCLUSION

The present study findings suggest that compensatory hypertrophy of the middle turbinate is not affected by septoplasty, even after one year.

Nasal air-conditioning after partial turbinectomy: myths versus facts

BACKGROUND

Turbinectomy, although a common procedure, is often accused of having a negative impact in all nasal functions. This study is the first in vivo study that evaluates objectively the effect of partial turbinectomy on nasal air-conditioning capacity.

METHODS

In total, 57 patients with prior partial inferior turbinectomy and 28 healthy controls were examined. Intranasal temperature and humidity values were measured at the level of the head of inferior and middle turbinate. Nasal patency was evaluated by means of acoustic rhinometry. The clinical assessment was completed with nasal endoscopy and the Nasal Obstruction Symptom Evaluation questionnaire for subjective evaluation of nasal patency.

RESULTS

Significant changes of temperature were found in both detection sites with 13% reduced heating capacity of the air at the level of the inferior and 19% at the level of the middle turbinate, respectively. No similar results were found for humidity measurements. No correlations were found between air-conditioning values and acoustic rhinometry results for both study groups. Nasal endoscopy revealed normal healing in all patients. No major complications were reported by the patients. Their subjective ratings of nasal obstruction were similar to healthy controls.

CONCLUSION

Partial turbinectomy seems to have a negative impact on intranasal air heating but not to humidification. This effect has no impact on clinical condition and subjective perception of surgical outcome.

Lobular capillary hemangioma formation: An unusual complication of submucous resection with power instrumentation of the inferior turbinate

Submucous resection with powered instrumentation (SRPI) is an effective surgical method to achieve inferior turbinate (IT) reduction with minimal morbidity. We describe a series of two cases of capillary hemangioma (pyogenic granuloma) that developed in the posterior third of the IT as a late complication after SRPI.

A comparative study of radiofrequency assisted versus microdebrider assisted turbinoplasty in cases of inferior turbinate hypertrophy

Nasal obstruction is the most common complaint among patients presenting to otolaryngologists which disturbs the quality of life of the patient. The anterior end of inferior turbinate is in the narrowest part of nasal airway, enlargement of which causes significant nasal obstruction. In our, prospective and interventional, study a comparison was made between the results of bipolar radiofrequency assisted turbinoplasty and microdebrider assisted turbinoplasty in patients with chronic nasal obstruction due to inferior turbinate hypertrophy, not responding to medical treatments. The cases were randomly divided into radiofrequency (RF) and microdebrider (MD) groups, each consisting of 30 cases. Nasal obstruction, sneezing, itching in nose, rhinorrhea, intra operative bleeding, duration of surgery, post operative bleeding, post operative pain and crusting were the parameters recorded preoperative, intra operative and post operatively at 1 week, 1, 3 and 6 months. For bleeding and crusting standard 4-point scale was used. Rest of the symptoms were assessed subjectively on standard visual analogue scale (0-10). The statistical analysis was done by student's t test. Postoperatively, all the preoperative symptoms were significantly improved up to 6 months in group RF as well as group MD, but there were three cases of recurrence at 6th months of postoperative period in group RF. However, we recommend MD assisted inferior turbinoplasty under local anaesthesia in view of long term symptom relief and lesser recurrence.

Septoturbinotomy

The inferior turbinates are a principal cause of nasal airway obstruction. To some extent, the bony septum (the perpendicular plate of the ethmoid) also, on occasion, contributes to that airflow obstruction. There are many excellent methods to resect or ablate the turbinates, including submucous resection and cauterization. However, some have been associated with bleeding, crusting, and the development of synechiae. In this Featured Operative Technique article, we propose 2 mechanical means to expand the nasal vault: (1) the insertion of a large and long speculum that outfractures the turbinates and also centralizes the bony septum when the handles are compressed and (2) the insertion of a large clamp, which is expanded (in reverse "nutcracker" fashion) to achieve a similar result. Mechanical dilation (expansion) of the nasal vault with the speculum or large clamp substantially improves vault diameter such that further work on the turbinates in the form of turbinectomy is seldom necessary. The nasal vault is not necessarily expanded to the maximal diameter that could be achieved with resection procedures but need not be to achieve satisfactory air flow. Septoturbinotomy is a quick and simple way to deal with inferior turbinate hypertrophy. It is a minimally invasive procedure that improves the airway in virtually all cases, such that turbinectomy is seldom employed. It can be used prophylactically on all rhinoplasty cases requiring lateral osteotomy, which potentially shrinks the nasal vault slightly.

Inferior turbinectomy for nasal obstruction review of 75 cases

98% of the patients had improved airway after surgery.All the patients with hyposmia had increased sensitivity to smell following surgery.80% of the patients with asthma and hypertrophied inferior turbinates benefited considerably with surgery as they had marked reduction in the frequency of asthmatic attack.In our study no cases of ozaena had been reported.There were no complications except for 3% of patients with epistaxis and synechiae.Patients with allergic symptoms had significant reduction in their sneezing attacks.8% of the patients reported mild dryness of the nasal cavity after surgery.8% of the patients also noticed not much improvement in their nasal discharge after surgery.

Patients with positive allergen test have less favorable outcome after endoscopic microdebrider-assisted inferior turbinoplasty

BACKGROUND

Endoscopic microdebrider-assisted inferior turbinoplasty is a newly developed surgical technique to treat patients with nasal obstruction. Although the procedure has been reported to be safe and effective, we tested the hypothesis that the prognosis might deteriorate with time in allergic rhinitis patients as identified by a positive allergen test in patients who have a persistent regional inflammation of the nose. We assessed the degree of nasal obstruction in a prospective cohort to investigate whether positive allergen test predicts outcome.

METHODS

In 70 consecutive patients, the symptom of nasal obstruction was evaluated subjectively by a visual analog scale (VAS) and objectively by acoustic rhinometry using cross-sectional area of the second notch (CSA-2) and nasal cavity volume before operation, and 3 months, 12 months after operation, respectively. Then, patients were classified and compared according to the multiple-antigen simultaneous test (MAST).

RESULTS

Both MAST(+) and MAST(-) groups showed statistically significant improvement in VAS score, CSA-2, and nasal cavity volume at 12 months after operation (p < 0.01). Of note, MAST(+) patients showed less favorable results than MAST(-) patients at 12 months after operation (p < 0.05).

CONCLUSION

Microdebrider-assisted inferior turbinoplasty provides effective relief for patients with nasal obstruction. However, such turbinate surgery may be successful only for a short period of time in patients with allergic rhinitis. Our finding suggests that, in selecting appropriate candidates, surgeons should consider criteria other than symptomatology, especially in patients with allergic rhinitis who may have manifestations other than at the level of the inferior turbinate contributing to nasal blockage.

Comparison of microdebrider-assisted inferior turbinoplasty and submucosal resection for children with hypertrophic inferior turbinates

OBJECTIVES

The aim of this study was to compare the effectiveness and safety of microdebrider-assisted inferior turbinoplasty (MAIT) with submucosal resection (SR) for children with hypertrophic inferior turbinates.

MATERIALS AND METHODS

One hundred and twenty children with chronic nasal obstruction due to hypertrophic inferior turbinates were enrolled. These children were randomly assigned to receive SR of the inferior turbinate (n=60) or MAIT (n=60). Ten children who did not appear to display any nasal discomfort served as normal controls. Surgical-outcome was evaluated with respect to four distinct parameters: nasal endoscopy, subjective assessment of nasal symptoms by the patient using a visual analogue scale, anterior rhinomanometry, and saccharin test. These evaluations were conducted before surgery and at 1 week, 1 and 3 months after surgery.

RESULTS

In the SR group, turbinate edema was decreased significantly at 1 and 3 months after surgery (p<0.05). Nasal secretions and crusting were increased significantly (p<0.05) in the SR group at 1 week after surgery and then decreased significantly at 1 and 3 months after surgery. In the MAIT group, turbinate edema and nasal secretions were decreased significantly at 1 and 3 months after surgery (p<0.05). Nasal crusting was not observed after surgery. Subjective complaints including nasal obstruction, sneezing, rhinorrhea and hyposmia were significantly improved in both groups from 1 month after surgery (p<0.05). Rhinomanometric assessment did not reveal significant improvement until 3 months after surgery in both groups. Saccharin transit time was significantly increased (p<0.05) compared to baseline at 1 week after surgery in the SR group but was not significantly different in the MAIT group.

CONCLUSION

MAIT and SR are both effective at relieving nasal obstruction due to the presence of hypertrophic inferior turbinates. MAIT is superior to SR with regard to preserving the nasal mucosa.

Evaluation of the turbinate hypertrophy by computed tomography in patients with deviated nasal septum

OBJECTIVES/HYPOTHESIS

To determine the dimensions of the compensatory hypertrophic inferior turbinate and investigate the radiological changes in the morphology of the conchal bone in patients with septal deviation.

STUDY DESIGN

A retrospective chart review.

METHODS

The mucosal and bone compartments of the hypertrophic turbinate were measured using computed tomography (CT) in patients with septal deviation, and the conchal bones were classified radiologically as lamellar, compact, and combined types. The results were compared with those of controls.

RESULTS

The dimensions of the bony and mucosal components of the inferior turbinate were significantly greater than those of controls in the anterior and middle segments, while the morphological changes in the conchal bone were not different.

CONCLUSION

The significant bony and mucosal enlargement in the anterior and middle segments of the inferior turbinate supports turbinate reduction at the time of septoplasty and the CT findings should be considered when making a decision about the reduction type.

Argon plasma coagulation in the treatment of nonallergic hypertrophic inferior nasal turbinates

PURPOSE

Various surgical procedures have been recently proposed for the treatment of hypertrophic inferior nasal turbinates as a result of the advances made in medical technology and growing public demand for minimally invasive therapies. The aim of this study was to evaluate the safety and efficacy of the argon plasma coagulation technique for inferior turbinate reduction in a homogeneous series of patients with nonallergic inferior turbinate hypertrophy.

MATERIAL AND METHODS

Twenty symptomatic patients underwent argon plasma coagulation surgical treatment under local anesthesia and were clinically followed up after 1 month and then every 3 months (anterior rhinoscopy and nasal endoscopy). Diagnostic evaluations using active anterior rhinomanometry were made after 3 and 12 months.

RESULTS

All of the patients reported a postoperative improvement in nasal swelling and patency. No postoperative complications were observed. Rhinomanometry after 12 months showed a reduction in mean total resistance from the pretreatment level of 1.06 Pa s/cm(3) to 0.49 Pa s/cm(3). There was also a statistically significant reduction in nasal resistance for each of the investigated conditions (inspiration and expiration in orthostatism and clinostatism).

CONCLUSIONS

Argon plasma coagulation is a safe and efficacious procedure for the minimally invasive treatment of inferior turbinate hypertrophy, which can be performed under local anesthesia in an outpatient setting with little discomfort for the patient.

A safe, alternative technique for inferior turbinate reduction

OBJECTIVE

Submucous resection of the inferior turbinates is a conventional technique for reducing their size to achieve patent nasal airways in situations where an enlarged turbinate contributes to airway obstruction. Many techniques and complications have been described in the past. We describe a new inferior turbinate reduction technique performed with powered instrumentation and assess its success and complication rates.

STUDY DESIGN

A prospective study of 120 consecutive patients who underwent submucous resection of the inferior turbinates with a microdebrider.

METHODS

Patient questionnaires were used for subjective assessment of symptoms before and after the procedure. We graded each patient's inferior turbinates for size from I to III before and 6 weeks after surgery for objective analysis.

RESULTS

The common complications of standard submucous resection of inferior turbinates include excessive resection, postoperative bleeding, and crusting. The advantage of the microdebrider technique is the precise control of the amount of tissue and location of tissue that is removed on a submucosal plane. The complications encountered with this technique are limited to postoperative bleeding that occurred in 1.6% of patients. There was no crusting or excessive removal of tissue.

CONCLUSION

The results show that submucous resection of inferior turbinates with a microdebrider is a safe method of achieving turbinate size reduction with minimal morbidity.

Radiofrequency tissue ablation of the inferior turbinates using a thermocouple feedback electrode

OBJECTIVE

The objective of this clinical trial was to assess the safety and efficacy of radiofrequency (RF) tissue ablation of the inferior turbinates in the treatment of nasal obstruction using an RF energy delivery system with a thermocouple feedback electrode.

METHODS

A prospective, nonrandomized study of 11 patients (mean age, 47+/-12 y) with chronic nasal obstruction was conducted. Using patient-based visual analogue scales (VAS), symptom parameters were assessed. These included degree of nasal obstruction, frequency of nasal obstruction, and pain. Physician assessment of nasal obstruction was also collected by the principal investigator. Follow-up was conducted at 24 hours, 1 week, 4 weeks, 8 weeks, and 1 year. ANOVA was carried out to determine statistically significant differences in the data. Data were fit to a regression model, and confidence intervals were determined from a 95% confidence level.

RESULTS

In patient-assessed degree of nasal obstruction, statistical significance was seen among baseline and 4 weeks, 8 weeks, and 1 year (P<.001, P<.0001, and P<.0008, respectively). There was no difference between 8 weeks and 1 year (P<.15). The data appeared to follow an exponential decay to a constant value. The pretreatment baseline average degree of obstruction was 7.5+/-0.5 on a scale of 0 to 10. The degree of obstruction after 8 weeks was 2.7+/-0.6. The time constant for this change was 21 days to reach 90% of the final value. At 1 year, degree of obstruction was 3.3+/-0.7. For frequency of nasal obstruction, statistical significance was seen among baseline and 4 weeks, 8 weeks, and 1 year (P<.0001, P<.0001, and P<.0001, respectively). There was no difference between 8 weeks and 1 year (P<.15). The pretreatment baseline average frequency of obstruction was 7.8+/-0.5. The remaining frequency of obstruction after 8 weeks was 2.9+/-0.6. The time constant was 18 days. At 1 year, frequency of obstruction was 3.3+/-0.6. Physician assessment of nasal obstruction revealed statistical significance among baseline and 4 weeks, and baseline and 8 weeks (P<.0055 and P<.0056, respectively). There was no difference between 4 weeks and 8 weeks (P<.24). The average initial obstruction was 83%+/-4%. The remaining obstruction after 8 weeks was 58% +/-5%. The time constant was 14 days. Mild pain was reported by 55% of patients during the procedure; the remaining 45% reported no pain. Only one patient required pain medication consisting of acetaminophen after the procedure. There were no significant complications.

CONCLUSIONS

Degree and frequency of nasal obstruction, as reported by patients, decreased following RF tissue ablation of the inferior turbinates. This improvement in symptoms was still evident after 1 year (P<.001). Physician assessment of obstruction also correlated with patient reports for the initial 8-week study period. The procedure was safe and well tolerated. Thermocouples within the active electrode provided additional feedback to the operating surgeon allowing the use of relatively lower tissue temperatures, power, and energy as compared with traditional techniques. These results support the need for continued research to evaluate this modality as a treatment for chronic nasal obstruction.

Endoscopic partial inferior turbinoplasty

Endoscopic partial inferior turbinoplasty with a microdebrider has been introduced as an alternative to other inferior turbinectomy techniques for the treatment of nasal airway obstruction. Between June 1994 and December 1997, 100 patients underwent endoscopic partial inferior turbinoplasty. Concurrent septoplasty was performed in 81 patients, and functional endoscopic sinus surgery was performed in 43 patients. Synechiae formation in 12 patients was the most common complication and resolved in nearly all cases. Postoperative improvement in nasal patency occurred in 93% of the patients. In the 48 patients for whom preoperative subjective scores were available, a significant difference was noted when comparing preoperative and postoperative subjective and outcome scores of nasal patency (P < 0.0001). Patients with underlying allergy and chronic sinusitis tended to have lower outcome scores. Postoperative rhinomanometry was obtained in 21 patients and revealed a normalized mean total nasal resistance of 0.23 Pa/mL/second. This improved to 0. 17 Pa/mL/second with topical decongestion (P = 0.0029), revealing the retention of the turbinate mucosa's vasoactive capability. We conclude that endoscopic partial inferior turbinoplasty provides a good alternative to other inferior turbinectomy techniques and is associated with excellent outcomes and minimal morbidity.

Treatment of hypertrophy of the inferior turbinate: long-term results in 382 patients randomly assigned to therapy

A number of surgical techniques are commonly performed to control the symptoms of inferior turbinate hypertrophy unresponsive to medical treatment. We report long-term results in 382 patients randomly assigned to receive electrocautery (62), cryotherapy (58), laser cautery (54), submucosal resection without lateral displacement (69), submucosal resection with lateral displacement (94), and turbinectomy (45). Outcomes of objective test results from rhinomanometry, acoustic rhinometry, mucociliary transport time, and secretory immunoglobulin A levels were compared to the symptom scores before and yearly after surgical treatment. These data indicate that submucosal resection with lateral displacement of the inferior turbinate results in the greatest increases in airflow and nasal respiratory function with the lowest risk of long-term complications.

S M R of inferior turbinate in chronic hypertrophic rhinitis

A study was undertaken to evaluate the role of unilatcral/bilateral submucous resection of the inferior turbinates in fifty cases of chronic hypertrophic rhinitis. Patients associated with deflected nasal septum or sinus infectious were excluded from the study. Decongesiton of turbinates was done to exclude the cases with predominantly mucosal hypertrophy. Gertner (1984) plate method was used to asses the nasal patency preoperatively and then post-operatively at 1, 3 and 6 months follow up. The analysis of observations made revealed SMR of inferior turbinate to be a very effective modality tor relieving nasal obstruction due to bony turbinal hypertrophy. The procedure has least interference with nasal mucosal integrity and functions and complications associated with the procedure have been found to be minimal. Histopathological examination of mucosa and of ostenid tissue revealed infiltration by chronic inflammatory cells suggesting chronic nonspecific inflammation either due to non-specific infections and / or allergy).

Endoscopic inferior turbinoplasty

Turbinectomy is a widely performed procedure for treatment of turbinate hypertrophy and chronic hypertrophic rhinitis. In this article an endoscopic variation of the inferior turbinoplasty is presented. This technique is rapid and simple and has the advantage of superior visualization during the elevation of the mucosal flap and resection of the turbinate. It allows precise tailoring of the resection to the needs of the patient. This procedure has been successfully performed in more than 30 patients without complication. The endoscopic inferior turbinoplasty is a safe and easy technique for treatment of inferior turbinate hypertrophy.

Inferior Turbinate Reduction Surgery in Children

We assessed the effectiveness and safety of surgical reduction of the inferior turbinate in 64 children, ages three to 15 years, who were operated on between January 1985 and November 1995. All patients/parents were interviewed and assessed by means of a questionnaire one to 10 years postoperatively. All patients had follow-up and were evaluated clinically at one and two weeks postoperatively. Long-term follow-up visits occurred at six, 12 and 24 months. Eighty-nine percent of the children/parents reported a sustained improvement in their nasal airways. No cases of serious postoperative hemorrhage, excessive dryness nor long-term crusting of the nose were observed or reported. We conclude that in the treatment of children with severe nasal obstruction, surgical reduction of the inferior turbinate is a safe and effective operation, alone or in combination with other airway procedures, and may increase the effectiveness of subsequent medical management.

Effect of Partial Middle Turbinectomy on Nasal Airflow and Resistance

We report the first prospective study of the effect of partial middle turbinectomy on nasal airflow and resistance as measured objectively by active anterior rhinomanometry. Our study group consisted of 31 consecutive patients who underwent functional endoscopic sinus surgery with simultaneous partial middle turbinate resections. We found that all patients had significant improvement in nasal airflow ( p < 0.001) and significant decrease in nasal resistance ( p < 0.001). Thus we found no deleterious effect on nasal function. Additionally, we reviewed the literature on retrospective series in which patients had received partial middle turbinectomies and found no evidence that nasal function was impaired after surgery. We conclude that partial middle turbinectomy may be performed without adversely altering nasal function, as measured by active anterior rhinomanometry.

Concho-antropexy or total inferior turbinectomy for hypertrophy of the inferior turbinates? A prospective randomized study

Twenty-five patients with bilateral nasal obstruction due to hypertrophy of the inferior turbinates were entered into a prospective study to compare the efficacy and the associated complications of total inferior turbinectomy and concho-antropexy. We found no significant statistical difference in the efficacy of these procedures in relieving nasal obstruction and discharge (p > 0.5). Total inferior turbinectomy was associated with more post-operative pain (p < 0.05) and with long-term dryness and crusting (p < 0.05) which were statistically significant. This is the first trial where concho-antropexy and total inferior turbinectomy are compared.

Inferior turbinate resection: the need for a nasal pack

A random prospective study of 180 patients with chronic nasal obstruction who underwent inferior turbinate resection as a part of a multinasal surgical procedure is presented. The aim of our study was to examine the influence of nasal pack on the incidence of post-operative haemorrhage following inferior turbinate resection. The haemorrhage rate in Group 1 (no nasal pack), Group 2 (nasal pack retained for 24 hours) and Group 3 (nasal pack retained for 48 hours) was 11.7, 8.3 and 0 per cent respectively. We recommend that a nasal pack should be retained for 48 hours following inferior turbinate resection.

Partial endoscopic middle turbinectomy augmenting functional endoscopic sinus surgery

Endoscopic sinus surgery has gained acceptance in the otolaryngologic community as an effective and safe method of treating inflammatory disease of the paranasal sinuses. At our institution, partial endoscopic middle turbinectomy has become a standard component of the procedure and our experience is reported. Middle turbinectomy enhances surgical exposure, specific anatomic anomalies are more completely corrected, and subpopulations of patients at risk for failure because of their underlying disease enjoy decreased rates of synechiae formation and closure of the middle meatus antrostomy when followed over time. Photodocumentation of the surgical technique and a discussion regarding the impact of middle turbinectomy on normal nasal physiology are presented. It is reported that the procedure is safe, and no complications directly attributable to middle turbinectomy (including atrophic rhinitis) are reported in a series of 298 patients.

'Two-stage turbinectomy': sequestration of the inferior turbinate following submucosal diathermy

Submucous diathermy of the inferior turbinates is a widely practised procedure. Three cases are presented in which surgery was complicated by avascular necrosis of the turbinate bone. Each patient required a debridement procedure before healing and recovery of normal mucociliary function could take place.

Inferior turbinectomy: comparison of four techniques

As yet, there is not totally satisfactory means for treating hypertrophied turbinates and the proper management of turbinate dysfunction remains in question. In the present series, four of the widely practiced surgical procedures for the reduction of the size of the inferior turbinates were evaluated and compared. In all cases turbinectomy was performed as an isolated procedure. Eighty patients with chronic non-allergic rhinitis and hypertrophied inferior turbinates were selected, randomly divided into four groups, and followed up post-operatively for one year. Study of the results indicated that the beneficial effect of the operation is mainly mechanical by reduction of the resistance to nasal airflow. The post-operative improvement in smell acuity correlated positively with the increased patency of the nasal airway. None of the procedures had a deleterious effect on olfactory acuity. In contrast, the operation failed to enhance the mucociliary clearance rate or significantly decrease nasal drainage. Partial inferior turbinectomy and laser turbinectomy improved nasal breathing in 77 per cent of patients, and enhanced olfactory acuity in 78 per cent of patients who had pre-operative hyposmia. The results of turbinoplasty and cryoturbinectomy were less favourable. The surgical technique, advantages, and drawbacks of each of these procedures are discussed.

Surgical reduction of the inferior turbinate in children: extended follow-up

The effectiveness and safety of surgical reduction of the inferior turbinate was assessed in 22 children of 15 years and below. All were interviewed and assessed by means of a questionnaire seven to 51 months post-operatively. Sixty-eight per cent of the children reported a sustained improvement in their nasal airway. There were no significant post-operative complications in this series. In particular there were no cases of serious post-operative haemorrhage, excessive dryness or crusting of the nose. It is concluded that surgical reduction of the inferior turbinate is a safe and effective option in the treatment of children with severe nasal obstruction.

Incidence of nasolacrimal injury and turbinectomy--associated atrophic rhinitis with Le Fort I osteotomies

Injury to the lacrimal system can occur with trauma, craniofacial surgery, rhinoplasty and nasal antrostomy. Nasolacrimal duct injury may potentially occur with Le Fort I superior repositioning. Atrophic rhinitis is also a potential complication secondary to turbinectomy required during Le Fort I superior repositioning. A review of thirty-four cases over three years of Le Fort I osteotomies with superior repositioning found no postoperative lacrimal injury and no subsequent atrophic rhinitis associated with turbinectomy. An anatomical study relating the position of the nasolacrimal duct opening within the inferior meatus and the distance available for maxillary impaction is reviewed.

Inferior turbinoplasty: patient selection, technique, and long-term consequences

When conservative medical management of symptomatically enlarged inferior turbinates is ineffective, the obstructing tissue may be reduced by an intramucosal or extramucosal destructive procedure (such as electrocautery, cryotherapy, or laser vaporization), or by conservative surgical resection. In the latter instance, enlarged conchal bones may be removed by the technique of turbinate submucous resection, while diffuse stromal hypertrophy necessitates partial resection of the inferior turbinates. A number of techniques of inferior turbinate surgery have been described. I have used the procedure of "inferior turbinoplasty" with increasing frequency for more than 9 years. Three to five years after such surgery, a detailed followup of 40 patients revealed none of the once-feared sequelae of turbinate resection, such as bleeding, crusting, foul nasal discharge, or bothersome postnasal drainage. Histologic examination of turbinates almost 5 years after turbinoplasty revealed fibrosis and scarring, with a marked decrease in mucous gland population, and normal mucosa. To obtain the best possible functional result inferior turbinate surgery is a necessary adjunct to most septal surgery. If conservatively done, it does not impair normal turbinate function. It must be stressed, however, that if the underlying cause of the turbinate hypertrophy is not addressed, recurrent obstruction can and probably will occur.

The early complications of inferior turbinectomy

A retrospective study has assessed the early complications occurring in 90 patients who underwent inferior turbinectomy during a 3-year period. The operation was complicated by haemorrhage, adhesions, crusting, infection and septal perforation in a proportion of cases, the overall incidence being 20 per cent, and that of significant reactionary or secondary haemorrhage was 9 per cent. Attention has been directed towards possible aetiological factors and measures proposed that may minimise the occurrence of complications.

The role of turbinectomy in rhinoplasty

Turbinectomy, in cases of inferior or middle turbinate hypertrophy, is one of the solutions for nasal breathing difficulties. For many decades, this procedure was controversial owing to the severe complications believed to occur after such an operation. Its performance was held to be within the responsibility of otolaryngologists. However, eventually most of these complications were found to be nonexistent, and the performance of turbinectomy became a simple surgical procedure. The turbinate hypertrophy, which often exists on the contralateral side of the deviated septum, blocks the correct reposition of the septum with the consequent nasal bone, and thus prevents the plastic surgeon from achieving a straight nose. Therefore, proper handling of both septal deviation and turbinate hypertrophy is an important aid for the plastic surgeon. This article is dealing with the various aspects of turbinate hypertrophy and its surgical handling.