| A turbinate reduction refers to any type of procedure to reduce the size of the nasal turbinate, and consequently increase the size of the nasal cavity. Turbinate reduction can be further subclassified into mucosal destruction or mucosal preservation techniques. Removal of nasal mucosa is a part of : 1) Inferior turbinate (IT) excision - partial or complete. Turbinate scissors are a part of most septoplasty trays across the country. The surgeon can remove the entire bottom of the turbinate (or the whole thing) involving mucosa, vascular tissue, and bone. When performed on the inferior turbinate patients will initially feel a satisfying flow of air through the nose. Some, but not all, of these patients go on to develop the symptoms of Empty Nose Syndrome (ENS) soon after or up to years later. Augmenting the nasal cavity for these ENS patients may be beneficial. I was taught how to snare the posterior IT during my residency - I now understand that this is not an area of nasal airflow restriction, so this technique is of little benefit to patients, and may cause bleeding. 2) Middle turbinate excision. Sometimes removal of the middle turbinate is required to gain access to the vault of the nose to repair a CSF leak of the fovea ethmoidalis or sphenoid sinus. Some surgeons remove part or all of the middle turbinate to aid in cleaning the ethmoid cavity after sinus surgery. Multiple patients describe ENS type symptoms, though also chronic pain symptoms, after this procedure. It is difficult to explain physiologically all the symptoms that some patients develop after MT resection. I advise against MT excision, unless absolutely necessary (e.g., CSF leak repair). We cannot predict who develops symptoms after MT excision, and who does not. The two sides can be treated in the same fashion, but the symptoms may be unilateral. 3) Laser therapy. The laser must first ablate normal nasal lining before it reaches the underlying vascular tissue (the ideal treatment site). The penetration is 4mm at best (an Nd:YAG laser). Crusting can develop at the site of mucosal loss/damage.You may see advertisements in the paper for this technique: the laser companies contract with a physician in the area to attract patients to their office. I am not infavor of such advertising, and I know the technique cannot treat all the symptoms/diseases it purports to treat. Mucosal preservation techniques include: 1) Inferior turbinate outfracture. The IT is fractured toward the wall of the nose, away from the septum. This provides some additional space within the nose for breathing. It is quite benign, but not hugely successful. I regularly employ this during nasal surgery. 2) IT intramural cautery or radifrequency. The vascular tissue beneath the mucosa is cauterized, or radiofrequency energy is applied, to reduce the vasculature's ability to swell and block the nose. This technique can help a great deal, but the effects tend to wear off after 9 months to a year. I do this technique in the office with the patient fully awake - local anesthesia is placed. 3) IT bone excision. The bone of the IT can be approached through an incision, and removed. This allows the IT mucosa to "sag" laterally and block the airway less. 4) IT submucosal microdebrider treatment. After placing an anterior incision, a Hummer (TM), or similar device used for sinus surgery, can be slid along the length of the IT submucosally. The vascular tissue can be partially excised, while the mucosa above remains intact. This works well for patients with chronically swollen IT. Patients with rhinitis medicamentosa who fail to respond to medical therapy (oral & topical steroids) seem to do great with this technique. Sleep apnea patients that get dependant IT swelling when they lay down also do well. The effects of this may be permanent, but we honestly have only been doing this for several years, so we cannot state this with certainty. I am in favor of this approach as I have seen it work worderfully well. |
| Turbinate Reduction |
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