The turbinates (choncae) are a bony ridge on the lateral wall of the nasal cavity, there are 3 turbinates each side (inferior middle and superior). They are covered with soft tissue which are responsible for humidification, warming and cleaning the are inspired through the nose.
Normally the turbinates swells and shrinks alternatively on each side during something called the nasal cycle which does not affecting the breathing through the nose and the patient will not feel nasal obstruction.
In cases of the abnormal hypertrophy (like allergy) the patient may feel nasal obstruction.
Indications of inferior turbinates surgery:
- Nasal congestion and rhinorrhea.
- Sleep apnea in case of using CPAP.
- Rhinitis medicamentosa (Chronic use of decongestants).
- Part of the surgery of the septum, septorhinoplasty or endoscopic sinus surgery in case the turbinates is hypertrophied.
What is Turbinates surgery:
There are many types of turbinates surgeries; the main idea of any turbinate surgery is to reduce the side the turbinate in order to improve the nasal passage.
- Turbinates lateralization: fracturing and lateral displacement of the turbinate.
- Turbinates soft tissue reduction: The creation of an area of submucosal thermal injury, which ultimately heals by fibrosis and scar contracture using either:
- Monopolar
- Bipolar
- Radiofrequency
- Soft Tissue Resection of the turbinates: Can be done using a specialized microdebrider blades.
- Bone Resection of the turbinates: Submucosal resection of the bone
- Turbinates Resection: Ranges from limited resection of the anterior aspect of the turbinate to total resections
Turbinates soft tissue reduction and soft Tissue resection of the turbinates are the two methods usually used in our department unless another type is indicated.
In preparing for the surgery you might need to do the following:
- Laboratory testing (blood tests) and possible medical assessment to be done before surgery.
- You need to be assessed by anesthesiologist in case done under general anesthesia.
- You may need to adjust your current medications if you are taking any. (like blood thinners…)
- Stop smoking.
- Avoid taking aspirin, anti-inflammatory drugs and some herbal supplements as they can increase the possibility of bleeding
The surgery can be done either under local anesthesia or general anesthesia. Alone or part of other surgeries as indicated.
Surgical steps:
- Preparing the nasal cavity with local anesthesia and nasal decongestant.
- In case of Turbinates soft tissue reduction a probe will be inserted submucosally to transmit the power used to ablate the soft tissue to decrease its size along the length of the inferior turbinate.
- In case of soft tissue resection of the turbinates a small incision will be done at the mos anterior part of the inferior turbinate to allow introduction of the microdebrider which will shave the mucosa systematically from anterior to posterior.
- In both cases the surface of the mucosa will spared.
- Hemostasis: making sure that there is no bleeding.
- Usually no packing is used unless medically indicated.
Recovery:
- If packing applied, then it will be removed within 24 hours (in some cases longer if the is a risk of bleeding).
- You will be given local medications to aid in healing and reduce the risk of infection, irrigations to clear the debris and analgesics (usually over the counter analgesics).
- The first period of time nasal blockage, discomfort and discharge will be experienced by the patients until the swelling subsides.
- The patient might experience crustations (debris of dead tissue in case if turbinates soft tissue reduction method is used) of for few weeks
Complications:
- Postoperative bleeding.
- If performed along with septoplasty scar tissue (adhesions) may form between the turbinate and the septum.
- All these complications and other less frequent complications will be mentioned and explained thoroughly in the pre surgical consent by the surgeon.
For detailed videos and images of this procedure,
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