What is
Inferior Turbinate Resection?
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.
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Effects
of Inferior Turbinate Resection
The primary advantage of this procedure is
addressing both bony and mucosal hypertrophy
of the entire length of the turbinate.
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Candidates
for Inferior Turbinate Resection
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.
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Your
Consultation
The inferior turbinates pose problems of
their own. Before surgery on an inferior
turbinate is undertaken, a trial of medical
management is mandatory. This usually
includes an antihistamine and decongestant,
treatment for nasal allergy (possibly
including the use of nasal cromolyn), and
immunotherapy. In addition, a systemic or
intranasal steroid should be tried.
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The Inferior Turbinate
Resection
Procedure
Should medical management fail, the
clinician has several options. The many
types of surgery for inferior turbinate
enlargement can be broadly classified into
three categories: (1) simple mechanical
means, such as crushing or lateral
fracturing, (2) destructive procedures, such
as electrocautery or laser vaporization,
which reduce the volume of the turbinate,
and (3) actual resection procedures, such as
submucosal resection, partial resection,
trimming of the turbinates, or inferior
turbinoplasty.
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Recovery
If significant bony or mucosal resection is involved,
postoperative packing may be placed. Various
dissolvable materials that facilitate
hemostasis are available. Traditional
nonabsorbable sponge packs can also be
placed and are usually removed within 24
hours after surgery. Postoperative bleeding
can usually be managed with topical
decongestants, hemostatic materials such as
Surgicel, or nasal packing. Persistent
bleeding despite these measures may require
a return to the operating room and possibly
endoscopy.
Instruct the patient to avoid heavy lifting
or strenuous activity for several weeks
after surgery (usually 2-3 weeks).
Similarly, patients should avoid medications
or herbs with anticoagulant effects for a
similar period. Nasal saline should be used
aggressively to minimize nasal dryness and
crusting postoperatively. This should be
continued until the mucosa has healed
completely. Once this has occurred,
adjunctive medical treatments such as
topical glucocorticoids can be resumed.
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Risks
The inferior turbinates are very vascular
structures and one of the risks of surgery
is hemorrhage. Patients with coagulopathies
are clearly at increased risk of
complications. Similarly, patients should
not be taking any medications or herbs that
affect their coagulation cascade.
Take care when resecting turbinate tissue in
patients who have preexisting complaints of
nasal dryness and crusting secondary to the
concern about atrophic rhinitis.
There is the risk of bleeding and
postoperative crusting. Long-term concerns
are rhinitis sicca, ozena, and atrophic
rhinitis.
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Frequently Asked
Questions
Q: What is the inferior turbinate?
A:
The inferior turbinate is large and fills
the lower portion of the nasal airway. It is
a long structure, and extends from the front
of the nose to the rear. The turbinate
functions to humidify the air, it shrinks
and swells to regulate nasal air resistance,
and it collects airborne particles on its
surface to clean the air.
Q: What causes enlargement of inferior
turbinates?
A:
There are two main reasons for enlargement.
Most of the time, enlarged inferior
turbinates are the result of allergies,
irritating environmental exposure, or some
minor persistent inflammation within the
sinuses. Another reason is deformity of the
nasal septum that has caused the bone on the
wider side of the turbinate to increase in
size. Large, swollen inferior turbinates
can lead to blockage of nasal breathing.
Q: What are the possible treatments for
inferior turbinates?
A:
In the case of allergy- or irritant-related
enlargement, treatment of the underlying
problem may reduce turbinate swelling and
solve the problem. If not, turbinate
reduction surgery may be required. Because
the turbinates help the nose to clean and
humidify the air we breathe, it is usually
better to leave as much tissue intact as
possible. The doctor will probably opt for
selective, or targeted, turbinate reduction
– rather than extensive reduction.
Q: What are the complications in this
procedure?
A:
Complications
associated with inferior turbinate surgery
include bleeding, crusting, dryness, and
scarring. If you undergo an inferior
turbinate reduction, your doctor may
prescribe a spray or watery solution to
relieve dryness and aid in healing. There is
generally less risk of serious complications
today than in the past, when inferior
turbinates were extensively cut out,
sometimes causing excessive crusting and
nasal dysfunction.
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