turbinate surgery

Turbinate Surgery

Department of Otolaryngology, Ajou University School of Medicine, May 27, 1998

Surgery for nasal obstruction

Several surgical procedures may be helpful relieving nasal obstruction which is refractory to medical management. Sometimes surgery is indicated primarily with an anatomical abnormality or neoplasm is suspected. Surgery, unless indicated primarily, should be delayed until the conservative measures failed.

Conchotomy(Turbinotomy)

The mucosal surface of the turbinate is removed with cutting forceps or turbinate scissors. The periosteum of the inferior turbinate bone should be preserved as much as possible for the prevention of bare bone exposure. The post-operative bleeding from the surgical wound can be avoided by preserving the intact peiosteum of the turbinate bone. This can be done by careful removal of the redundant mucosa only. Nasal crusts are post-operative problems about 7 - 10 days. But most of the patients do not suffer from nasal crusting after 2-3 weeks.

Turbinoplasty

Instead of submucosal resection of the turbinate bone, the lateral part of the inferior turbinate bone and the overlying mucosa are removed. And then medial side remnant turbinate tissues are rolled up and displaced laterally to cover the bare bone as a mucosal flap. This procedure is simpler than submucosal turbinectomy and effective for the nasal obstruction.

Laser conchotomy(LACON)/ Electrocautery

Laser conchotomy can done from simple mucosal anterior vaporization to the total turbinate vaporization. This procedure is known to be effective for the allergic rhinitis mainly with CO2 laser. Some doctors use Nd-YAG laser for submucosal vaporization.

Submucous resection is performed on an anatomically deviated, obstructing inferior turbinate, or if obstructing hypertrophic mucosa is unresponsive to vigorous medical management.
As an isolated operation, submucous resection of the inferior turbinate is usually done under local anesthesia. Anesthesia and vasoconstriction is then achieved as in septoplasty. If general anesthesia is used, the technique is the same to achieve maximal vasoconstriction.
After vasoconstriction and anesthesia is achieved, an incision is made with a No. 12 Bard-Parker blade from posterior to anterior along the inferior edge of the inferior turbinate continuing up the anterior aspect of the turbinate. Using a Freer or Cottle elevator, the mucoperiosteum is elevated off the medial and lateral aspects of the turbinate bone. The inferior turbinate bone is fractured and removed subperiosteally with a Takahashi forceps or Jansen-Middleton rongeur, carefully preserving the mucoperiosteal flaps. Excessive mucosa can be judiciously trimmed from the inferior portions of the mucoperiosteal flaps, especially the lateral one. The remaining mucoperiosteum is reflected laterally over the bare bone of the inferior turbinate remnant and packed in place with Vaseline/antibiotic gauze for 4 to 6 days.
Alternate methods of dealing with hypertrophic inferior turbinate mucosa include cryotherapy, linear submucosal central or inferior external electrodessication, or laser debulking. These methods, while simpler, are often less precise and produce additional bleeding and crusting during the healing period. Simple excision of the inferior turbinates, once advocated, often producSes severe ozena and nasal dysfunction. Outfracture of the inferior turbinates can be useful for anatomical bony deviations but is not helpful for mucosal hypertrophy of dependent congestion.

Clinical Indicators
from
The American Academy of Otolaryngology-Head and Neck Surgery for surgical procedures:

Clinical Indicators for Turbinectomy

Indicators

History of chronic nasal obstruction with inadequate management (describe management - medications, allergy treatment, duration)
Physical examination
Turbinate hypertrophy causing nasal obstruction
Description of remaining nasal anatomy
Optional tests
Allergy evaluation
Rhinomanometry
Radiographic imaging (eg, CT scan)

Postoperative observations (instructions for nurses and residents)

Nasal packing in desired location or removed (depending on surgeon's specific orders)
Bleeding - change outer dressing or if bleeding is active at time of discharge notify surgeon

Outcome Review

At 1 week:
Was treatment required for bleeding or infection?
Beyond 1 month:
Is the presenting problem improved?
Is there a crusting problem?

Patient Information

A turbinectomy is the surgical removal of an abnormally enlarged inferior (lower) or middle turbinate from inside the nose in order to improve breathing. It is considered to be a safe and effective procedure to relieve complaints of nasal stuffiness, snoring, and difficult nasal breathing. When the middle turbinate is either partially or completely removed, it also allows the surgeon better access to infected sinuses, because turbinectomy is often combined with other sinus or nasal surgical procedures. It may be performed under local or general anesthesia. Sometimes the inferior turbinate is cauterized or frozen rather than removed in order to make it smaller.
Complications associated with turbinectomy are crusting, dryness, scarring, and bleeding. Postoperative bleeding is not uncommon and can be controlled. Sprays or watery solutions are prescribed to relieve dryness and aid in healing.