Dilemma of Inferior Turbinate Surgery
Advances in Surgical Sciences
Volume 3, Issue 2, April 2015, Pages: 8-18
Received: May 2, 2015; Accepted: Jun. 21, 2015; Published: Jul. 6, 2015
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Khaled Mohamed Bofares, Otorhinolaryngology, Omar Almoukhtar University, Elbyda, Libya
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Background and objectives: Inferiorturbinate surgery is considered as one of most commonly performed surgery in rhinology. It is usually done to reduce the bulk of inferior turbinates. It can be conducted for different indications such as relieving the mechanical nasal obstruction due to hypertrophied inferior turbinates, or to achieving a sufficient nasal surgical access during endoscopic sinus surgery, or removing the inferior turbinates as a part of wide and complete resection of rhino-sinus neoplastic lesions. The inferior turbinates have important role in the maintenance of nasal breathing function by providing the nasal valve mechanism necessary for the regulation of air flow through the nose. In spite of availability of well-established variable techniques for this surgery, the main goal of this surgery is yet not completely achieved. This could bean effect of different factors that are difficult to be predicted and controlled. Hence this pattern of surgery has become dilemmas in rhinology which need to be deeply evaluated and subsequently resolved. In order to evaluate and resolve this dilemma, this serial study was conducted prospectively. Patients and methods: 1337 patients aged 3 to -65 years suffering from hypertrophied inferior turbinates, presented with clinical pictures of mechanical nasal obstruction at ENT department – of Althowra central hospital and Al-tarahom private center Elbyda city- Libya between September 2005 to September 2014 they were operated by variable techniques of inferior turbinate surgery, namely sub-mucosal diathermy (SMD) (n=864 ), partial inferior turbinectomy (PIT) (n=427), CO2 laser vaporization of inferior turbinate (n=21), and turbinoplasty (n=25) . Post-operative atrophic rhinitis, and persistence, or recurrence of mechanical nasal obstruction the outcomes are that were studied in relation to different factors to shed-light on existing dilemma. Results and Conclusion: Proper selection of patient for this pattern of surgery is considered one of the main aspects of this issue and one of significant steps towards resolving of this dilemma. On the other hand, type of the technique for this surgery is an important selection criterion. In addition the amount of the inferior turbinate needed to be resected must be decided.
Inferior Turbinate Surgery, Inferior Turbinectomy, Sub-Mucosal Diathermy, Turbinoplasty
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Khaled Mohamed Bofares, Dilemma of Inferior Turbinate Surgery, Advances in Surgical Sciences. Vol. 3, No. 2, 2015, pp. 8-18. doi: 10.11648/j.ass.20150302.11
Takeuchi H, Jawad M, Eccles R. Changes in unilateral nasal airflow in patients with seasonal allergic rhinitis measured in and out of season. Auris Nasus Larynx. 2000 Apr; 27(2):141-5.
Jones AS, Lancer JM, Moir AA, Stevens JC. The effect of submucosal diathermy to the inferior turbinates on nasal resistance to airflow in allergic and vasomotor rhinitis. Clin Otolaryngol Allied Sci. 1985 Oct; 10(5):249-52.
Fradis M, Malatskey S, Magamsa I, Golz A. Effect of submucosal diathermy in chronic nasal obstruction due to turbinate enlargement. Am J Otolaryngol. 2002 Nov-Dec;23(6):332-6.
von Haacke NP, Hardcastle PF. Submucosal diathermy of the inferior turbinate and the congested nose. ORL J Otorhinolaryngol Relat Spec. 1985; 47(4):189-93.
Talaat M, el-Sabawy E, Baky FA, Raheem AA.Submucous diathermy of the inferior turbinates in chronic hypertrophic rhinitis.J Laryngol Otol. 1987 May; 101(5):452-60.
Jones AS, Lancer JM.Does submucosal diathermy to the inferior turbinates reduce nasal resistance to airflow in the long term?J Laryngol Otol. 1987 May; 101(5):448-51.
Flanagan P, Eccles R.Physiological versus pharmacological decongestion of the nose in healthy human subjects. Acta Otolaryngol. 1998 Jan; 118(1):110-3.
Lin Chuang Er Bi Yan Hou Ke Za Zhi.The effect of submucosal diathermy to the inferior turbinates on nasal airway resistance. 2001 Aug; 15(8):354-5.Chinese.
Farmer SE, Quine SM, Eccles R.Efficacy of inferior turbinate coblation for treatment of nasal obstruction.J Laryngol Otol. 2009 Mar; 123(3):309-14. doi: 10.1017/S0022215108002818. Epub 2008 Jun 9.
Ikeda K, Oshima T, Suzuki M, Suzuki H, Shimomura A.Functional inferior turbinosurgery (FITS) for the treatment of resistant chronic rhinitis. Acta Otolaryngol. 2006 Jul; 126(7):739-45.
Cook JA, McCombe AW, Jones AS.Laser treatment of rhinitis--1 year follow-up.ClinOtolaryngol Allied Sci. 1993 Jun; 18(3):209-11.
Thomas PL, John DG, Carlin WV.The effects of inferior turbinate outfracture on nasal resistance to airflow in vasomotor rhinitis assessed by rhinomanometry.J Laryngol Otol. 1988 Feb; 102(2):144-5.
Wight RG, Jones AS, Beckingham E. Radical trimming of the inferior turbinates and its effect on nasal resistance to airflow.J Laryngol Otol. 1988 Aug; 102(8):694-6. No abstract available.
Gindros G, Kantas I, Balatsouras DG, Kandiloros D, Manthos AK, Kaidoglou A.Mucosal changes in chronic hypertrophic rhinitis after surgical turbinate reduction.Eur Arch Otorhinolaryngol. 2009 Sep; 266(9):1409-16. doi: 10.1007/s00405-009-0916-9. Epub 2009 Jan 30.
Bäck LJ, Hytönen ML, Malmberg HO, Ylikoski JS. Submucosal bipolar radiofrequency thermal ablation of inferior turbinates: a long-term follow-up with subjective and objective assessment. Laryngoscope. 2002 Oct; 112(10):1806-12.
Chen YL, Tan CT, Huang HM.Long-term efficacy of microdebrider-assisted inferior turbinoplasty with lateralization for hypertrophic inferior turbinates in patients with perennial allergic rhinitis. Laryngoscope. 2008 Jul; 118(7):1270-4. doi: 10.1097/MLG.0b013e31816d728e.
Elwany S, Gaimaee R, Fattah HA. Radiofrequency bipolar submucosal diathermy of the inferior turbinates. Am J Rhinol. 1999 Mar-Apr; 13(2):145-9.
Chen YL, Liu CM, Huang HM.Comparison of microdebrider-assisted inferior turbinoplasty and submucosal resection for children with hypertrophic inferior turbinates. Int J Pediatr Otorhinolaryngol. 2007 Jun; 71(6):921-7. Epub 2007 Apr 5.
Mori S, Fujieda S, Yamada T, Kimura Y, Takahashi N, Saito H.Long-term effect of submucousturbinectomy in patients with perennial allergic rhinitis. Laryngoscope. 2002 May; 112(5):865-9.
Mittelman H.CO2 laser turbinectomies for chronic, obstructive rhinitis.Lasers Surg Med. 1982; 2(1):29-36.
Janda P, Sroka R, Betz CS, Grevers G, Leunig A.Ho:YAG and diode laser treatment of hyperplastic inferior nasal turbinates. Laryngorhinootologie. 2002 Jul; 81(7):484-90. German.
Tanigawa T, Yashiki T, Hayashi K, Sato T. Carbon dioxide laser vaporization for turbinate: optimal conditions and indications. Auris Nasus Larynx. 2000 Apr; 27(2):137-40.
Imamura S, Honda H.Carbon dioxide laser vaporization of the inferior turbinate for allergic rhinitis: short-term results. Ann Otol Rhinol Laryngol. 2003 Dec; 112(12):1043-9.
Sroka R, Janda P, Killian T, Vaz F, Betz CS, Leunig A.Comparison of long term results after Ho:YAG and diode laser treatment of hyperplastic inferior nasal turbinates. Lasers Surg Med. 2007 Apr; 39(4):324-31.
Sapçi T, Sahin B, Karavus A, Akbulut UG. Comparison of the effects of radiofrequency tissue ablation, CO2 laser ablation, and partial turbinectomy applications on nasal mucociliary functions. Laryngoscope. 2003 Mar;113(3):514-9.
Fukutake T, Yamashita T, Tomoda K, Kumazawa T.Laser surgery for allergic rhinitis.Arch Otolaryngol Head Neck Surg. 1986 Dec; 112(12):1280-2.
Lippert BM, Werner JA.CO2 laser surgery of hypertrophied inferior turbinates. Rhinology. 1997 Mar; 35(1):33-6.
Ogawa T, Takeno S, Ishino T, Hirakawa K.Submucousturbinectomy combined with posterior nasal neurectomy in the management of severe allergic rhinitis: clinical outcomes and local cytokine changes. Auris Nasus Larynx. 2007 Sep; 34(3):319-26. Epub 2007 Apr 11.
Orabi AA, Sen A, Timms MS, Morar P.Patient satisfaction survey of outpatient-based topical local anesthetic KTP laser inferior turbinectomy: a prospective study. Am J Rhinol. 2007 Mar-Apr; 21(2):198-202.
Kawamura S, Fukutake T, Kubo N, Yamashita T, Kumazawa T.Subjective results of laser surgery for allergic rhinitis. Acta Otolaryngol Suppl.1993; 500:109-12.
Takeno S, Osada R, Ishino T, Yajin K.Laser surgery of the inferior turbinate for allergic rhinitis with seasonal exacerbation: an acoustic rhinometry study.Ann Otol Rhinol Laryngol. 2003 May; 112(5):455-60.
Jovanovic S, Dokic D.Nd:YAG laser surgery in treatment of allergic rhinitis. Laryngorhinootologie. 1995 Jul; 74(7):419-22. German.
Janda P, Sroka R, Baumgartner R, Grevers G, Leunig A.Laser treatment of hyperplastic inferior nasal turbinates: a review. Lasers Surg Med. 2001; 28(5):404-13. Review.
Schmidt J, Zalewski P, Olszewski J, Olszewska-Ziaber A. Histopathological verification of clinical indications to partial inferior turbinectomy. Rhinology. 2001 Sep; 39(3):147-50.
Ishida H, Yoshida T, Hasegawa T, Mohri M, Amatsu M. Submucouselectrocautery following submucous resection of turbinate bone--a rationale of surgical treatment for allergic rhinitis. Auris Nasus Larynx. 2003 May; 30(2):147-52.
Chhabra N, Houser SM. The surgical management of allergic rhinitis. Otolaryngol Clin North Am. 2011 Jun; 44(3):779-95, xi. doi: 10.1016/j.otc.2011.03.007. Review.
Englender M. Nasal laser mucotomy (L-mucotomy) of the inferior turbinates. J Laryngol Otol. 1995 Apr; 109(4):296-9.
Jovanovic S, Dokic D.Does laser turbinectomy influence local allergic inflammation in the nose?Rhinology. 1996 Mar; 34(1):46-9.
Vijay Kumar K, Kumar S, Garg S.A comparative study of radiofrequency assisted versus microdebrider assisted turbinoplasty in cases of inferior turbinate hypertrophy.Indian J Otolaryngol Head Neck Surg. 2014 Jan; 66(1):35-9. doi: 10.1007/s12070-013-0657-3. Epub 2013 May 5.
Cavaliere M, Mottola G, Iemma M. Comparison of the effectiveness and safety of radiofrequency turbinoplasty and traditional surgical technique in treatment of inferior turbinate hypertrophy. Otolaryngol Head Neck Surg. 2005 Dec; 133(6):972-8.
Rhee CS, Kim DY, Won TB, Lee HJ, Park SW, Kwon TY, Lee CH, Min YG.Changes of nasal function after temperature-controlled radiofrequency tissue volume reduction for the turbinate.Laryngoscope. 2001 Jan; 111(1):153-8.
Cassano M, Granieri C, Del Giudice AM, Mora F, Fiocca-Matthews E, Cassano P.Restoration of nasal cytology after endoscopic turbinoplasty versus laser-assisted turbinoplasty.Am J Rhinol Allergy. 2010 Jul-Aug; 24(4):310-4. doi: 10.2500/ajra.2010.24.3474.
Lorenz KJ, Maier H.Microdebrider-assisted inferior turbinoplasty. Minimally invasive technique for the treatment of nasal airway obstruction caused by enlarged turbinates. HNO. 2013 Mar; 61(3):240-9. doi: 10.1007/s00106-012-2553-7. German.
Yanez C, Mora N. Inferior turbinate debriding technique: ten-year results. Otolaryngol Head Neck Surg 2008; 138:170-5.
Sacks R, Thornton MA, Boustred RN.Modified endoscopic turbinoplasty - long term results compared to submucosal electrocautery and submucosal powered turbinoplasty. Presented at the American Rhinologic Society, May 14, 2005.
Passali D, Passali FM, Damiani V, Passali GC, Bellussi L. Treatment of inferior turbinate hypertrophy: a randomized clinical trial. Ann Otol Rhinol Laryngol. 2003, 112:683-688.
Lai VWS, Corey JP.The objective assessment of nasal patency. Ear Nose Throat J. 1993, 72:395-400.
Seeger J, Zenev E, Gundlach P, et al. Bipolar radiofrequency-induced thermotherapy of turbinate hypertrophy: pilot study and 20 months follow-up. Laryngoscope.2001, 113:130-5.
Jackson LE, Koch RJ. Controversies in the management of inferior turbinate hypertrophy: a comprehensive review. PlastReconstr Surg. 1999, 103:300-312.
Hol MKS, Huizing EH. Treatment of inferior turbinate pathology: a review and critical evaluation of the different techniques. Rhinology.2000, 38:157-66.
Camelo-Nunes IC, Solé D. Allergic rhinitis: indicators of quality of life. J Bras Pneumol. 2010, 36(1):124-33.
Stewart MG, Witsell DL, Smith TL, Weaver EM, Yueh B, Hannley MT. Development and validation of the Nasal Obstruction Symptom Evaluation (NOSE) scale. Otolaryngol Head Neck Surg. 2004, 130(2):157-63.
Stewart MG, Smith TL, Weaver EM, Witsell DL, Yueh B, Hannley MT, Johnson JT. Outcomes after nasal septoplasty: results from the Nasal Obstruction Septoplasty Effectiveness (NOSE) study. Otolaryngol Head Neck Surg. 2004, 130(3):283-90.
Sapçi T, Sahin B, Karavus A, Akbulut UG. Comparison of the effects of radiofrequency tissue ablation, CO2 laser ablation, and partial turbinectomy applications on nasal mucociliary functions. Laryngoscope. 2003, 113(3):514-9.
Cavaliere M, Mottola G, Iemma M. Comparison of the effectiveness and safety of radiofrequency turbinoplasty and traditional surgical technique in treatment of inferior turbinate hypertrophy. Otolaryngol Head Neck Surg. 2005, 133(6):972-8.
Bhandarkar ND, Smith TL.Outcomes of surgery for inferior turbinate hypertrophy. Curr Opin Otolaryngol Head Neck Surg. 2010, 18(1):49-53.
Leong SC, Eccles R. Inferior turbinate surgery and nasal airflow: evidence-based management. CurrOpinOtolaryngol Head Neck Surg. Feb 2010; 18(1):54-9.
Hol MK, Huizing EH. Treatment of inferior turbinate pathology: a review and critical evaluation of the different techniques. Rhinology. Dec 2000; 38(4):157-66.
Hanif J, Jawad SS, Eccles R.The nasal cycle in health and disease. Clin Otolaryngol Allied Sci. Dec 2000; 25(6):461-7.
Farmer SE, Eccles R. Chronic inferior turbinate enlargement and the implications for surgical intervention.Rhinology. Dec 2006; 44(4):234-8.
Bhandarkar ND, Smith TL. Outcomes of surgery for inferior turbinate hypertrophy. Curr Opin Otolaryngol Head Neck Surg. Feb 2010; 18(1):49-53.
Ozcan KM, Gedikli Y, Ozcan I, Pasaoglu L, Dere H. Microdebrider for reduction of inferior turbinate: evaluation of effectiveness by computed tomography. J Otolaryngol Head Neck Surg. Aug 2008; 37(4):463-8.
Chhabra N, Houser SM.The diagnosis and management of empty nose syndrome. Otolaryngol Clin North Am. Apr 2009; 42(2):311-30, ix.
Batra PS, SeidenAM, Smith TL. Surgical management of adult inferior turbinate hypertrophy: a systematic review of the evidence. Laryngoscope. Sep 2009; 119(9):1819-27.
Tanna N, Im DD, Azhar H, Roostaeian J, Lesavoy MA, Bradley JP, et al. Inferior turbinoplasty during cosmetic rhinoplasty: techniques and trends. Ann Plast Surg. Jan 2014; 72(1):5-8.
Schumacher MJ. Nasal dyspnea: the place of rhinomanometry in its objective assessment. Am J Rhinol. Jan-Feb 2004; 18(1):41-6.
Eccles R, Jawad MS, Jawad SS, Angello JT, Druce HM. Efficacy and safety of single and multiple doses of pseudoephedrine in the treatment of nasal congestion associated with common cold. Am J Rhinol. Jan-Feb 2005; 19(1):25-31.
Garzaro M, Pezzoli M, Landolfo V, Defilippi S, Giordano C, Pecorari G. Radiofrequency Inferior Turbinate Reduction: Long-Term Olfactory and Functional Outcomes. Otolaryngol Head Neck Surg. Sep 20 2011.
Tanna N, Lesavoy MA, Abou-Sayed HA, Gruber RP. Septoturbinotomy. AesthetSurg J. Nov 1 2013; 33(8):1199-205.
Gupta A, Mercurio E, Bielamowicz S. Endoscopic inferior turbinate reduction: an outcomes analysis.Laryngoscope. Nov 2001; 111(11 Pt 1):1957-9.
Lee JY, Lee JD. Comparative study on the long-term effectiveness between coblation- and microdebrider-assisted partial turbinoplasty. Laryngoscope. May 2006; 116(5):729-34.
Daniel Simmen, ‏Nick S. Jones. Lateral nasal wall lateralization and pyriformturbinoplasty. in: Manual of Endoscopic Sinus and Skull Base Surgery. 2013; 108a-b.
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