Total inferior turbinectomy for nasal airway obstruction

A variety of surgical procedures are performed to open the nasal airway chronically obstructed by hypertrophic inferior turbinates. Because the results are universally unsatisfactory, we suggest bilateral total inferior turbinectomy to patients in whom medical therapy fails. One hundred fifty patients were followed up for one to seven years (mean, 2 1/2 years) and the results of the follow-up were assessed clinically via questionnaire and chart review. Patent nasal airway resulted in 91% of the patients. Eighty percent of the patients reported improvement in nasal breathing, and 14 (27%) of the 51 patients who suffered from nasal drainage preoperatively reported that it had stopped after the operation. Of the 39 patients who had anosmia preoperatively, 46% reported the restoration of their sense of smell. Postoperative complications are minimal, and no patient complained of crusts, dryness, or foul odor.     

Inferior turbinectomy for nasal obstruction review of 75 cases

Conclusion  

Complications following total inferior turbinectomy: facts or myths?

Various surgical procedures have been described for the relief of chronic nasal obstruction due to inferior turbinate hypertrophy, but none has been consistently satisfactory. We have performed total inferior turbinectomy for this condition for 5 years. Of the 39 patients followed for at least 2 years, 90% were relieved permanently of nasal obstruction. However, only 36% and 61% of patients with rhinorrhoea and anosmia respectively were relieved of these symptoms. Complications were minimal. It is concluded that even in a dry, dusty tropical climate, inferior turbinectomy does not appear to disturb the function of the nasal cavity appreciably.     

鼻腔外侧壁黏骨膜下下鼻甲部分切除术治疗慢性肥厚性鼻炎

目的探讨鼻腔外侧壁黏骨膜下下鼻甲部分切除术治疗慢性肥厚性鼻炎的疗效,并介绍鼻腔外侧壁黏骨膜下下鼻甲部分切除术的手术方法。方法28例慢性肥厚性鼻炎患者,鼻窦CT证实下鼻甲骨性肥大,行鼻腔外侧壁黏骨膜下下鼻甲部分切除术,术前及术后3、12个月检查鼻阻力（nasal airway resistance,NAR）及应用VAS（visual analogue scale）评分法评价鼻通气功能。结果28例患者中痊愈20例,好转6例,无效2例。无鼻腔干燥、结痂、粘连、鼻泪管开口闭锁等并发症,下鼻甲形态满意。结论经鼻腔外侧壁黏骨膜下下鼻甲部分切除术是治疗慢性肥厚性鼻炎的有效方法。     

Nasolacrimal obstruction after inferior meatus nasal antrostomy

Transient epiphora following rhinoplasty or intranasal procedures is a common occurrence. Permanent nasolacrimal duct obstruction, however, is rare. This article documents four cases of nasolacrimal duct obstruction following intranasal antrostomy. Three patients were cured by dacryocystorhinostomy and a fourth refused surgery. The anatomy of the nasolacrimal duct in the inferior meatus has considerable variation. Although the duct typically opens in the inferior meatus immediately under the insertion of the inferior turbinate, the orifice can be a single hole, a slit, multiple holes, or a trough, and can be located anywhere from 30 to 40 mm dorsal to the anterior nares. We review the embryology and anatomy of the nasolacrimal orifice in the nose and make recommendations for safe surgery in the inferior meatus.     

How we do it: Radiofrequency‐turbinectomy for nasal obstruction symptoms

? Radiofrequency energy has been reported to be effective to reduce nasal obstruction because of inferior turbinate hypertrophy. ? A total of 158 patients who had undergone such surgery are reported. ? Three to 30 months postoperatively 85% of the patients reported a marked decrease in nasal obstruction. This was irrespective of a short‐term or a long‐term follow‐up, and was applicable to patients that had septal deviations in addition. ? Radiofrequency‐turbinectomy is a simple and effective method for treatment of nasal obstruction as a result of hypertrophy of the inferior turbinates, even if combined with a moderate septal deviation.     

Assessment of symptom improvement following nasal septoplasty with or without turbinectomy

Most studies show that objective measures to quantify and determine surgical success in the treatment of nasal obstruction do not correlate with subjective improvement as reported by patients.AimTo evaluate the subjective improvement of nasal symptoms in patients undergoing septoplasty with or without turbinectomy.Materials and methodsA prospective study. We evaluated 72 septoplasty patients with or without partial inferior turbinectomy; the patients answered a questionnaire preoperatively and on the 60th day after surgery.ResultsSeptoplasty was done associated with bilateral partial inferior turbinectomy in 83.3% of patients; it was unilateral in 9.7%; there was no need for turbinate reduction in 6.9%. An improvement of all symptoms was observed after surgery. Nasal obstruction had improved in 68 patients (94.4%) by the 60th postoperative day. The average nasal obstruction score in patients with and without allergic symptoms was similar before surgery and on the 60th postoperative day. Older patients had milder preoperative allergic symptoms.ConclusionsNasal symptoms in patients undergoing septoplasty, with or without turbinectomy, improved. Patients with and without allergic symptoms showed a similar improvement of nasal obstruction on the 60th postoperative day.     

鼻内窥镜引导半导体激光下鼻甲部分切除术的临床探讨

目的：探讨鼻内窥镜引导下行半导体激光下鼻甲部分切除术的应用价值。方法：回顾分析56例慢性肥厚性鼻炎患者在鼻内窥镜引导下行半导体激光下鼻甲部分切除术的临床资料。结果：术后半年复查,总有效率94．64％,术中无出血,术后无并发症。结论：半导体引导下激光下鼻甲部分切除术方法简便、快捷、有效,是治疗慢性肥厚性鼻炎的有效方法。     

The early complications of inferior turbinectomy

A retrospective study has assessed the early complications occurring in 90 patients who underwent inferior turbinectomy during a 3-year period. The operation was complicated by haemorrhage, adhesions, crusting, infection and septal perforation in a proportion of cases, the overall incidence being 20 per cent, and that of significant reactionary or secondary haemorrhage was 9 per cent. Attention has been directed towards possible aetiological factors and measures proposed that may minimise the occurrence of complications.     

A review of outcomes following inferior turbinate reduction surgery in children for chronic nasal obstruction

Background

The surgical management of enlarged inferior turbinates in children is controversial. The evidence base for turbinate surgery is weak and surgeons empirically offer surgery where the predominant symptom was nasal obstruction.

Objective

To evaluate the evidence for inferior turbinate surgery in children suffering with chronic nasal congestion.

Methods

A structured review of the PubMed, EMBASE and the Cochrane Collaboration databases (Cochrane Central Register of Controlled Trials, Cochrane Database of Systemic Reviews) was undertaken, using the MeSH terms: nasal obstruction, turbinates, surgery and children. Only articles focusing on turbinate surgery with an exclusively paediatric cohort were included.

Results

Eleven studies fulfilled the inclusion criteria. The ages of the children ranged from 1 to 17 years at the time of surgery and were followed-up for a period of 3 months to 14 years. Surgical indication for all studies was chronic nasal congestion, resistant to a trial of medical treatment for 2-3 months preceding surgery. Of the 730 cases reviewed, 79.1% had turbinate surgery as the standalone procedure. The remaining 21.9% had other concurrent procedures performed, the most common being adeno-tonsillectomy. Although all studies generally supported the effectiveness of turbinate reduction surgery for inferior turbinate hypertrophy, the outcome measures used were varied and did not allow comparison across studies.

Conclusions

There is currently little evidence to support turbinate reduction surgery in children. The role of surgery, if any, has not been properly examined. Furthermore, the long-term effects on nasal airflow dynamics, nasal physiology and long-term complications remain to be studied.     

等离子下鼻甲部分消融术与吸切钻下鼻甲部分切除术

目的比较等离子下鼻甲部分消融术与吸切钻下鼻甲部分切除术对慢性肥厚性鼻炎患者术中、术后的影响。方法等离子组患者25例,对照组14例。等离子组用低温等离子射频消融系统连接45号刀头,行下鼻甲前、后部中隔侧的4～6通道消融。对照组用吸切钻自前向后切割下鼻甲肥厚黏膜,术后需填塞止血2日。术后患者对疼痛和鼻堵程度采用VAS评分。术前、术后1个月、3个月、6个月均由医师对每侧下鼻甲进行评分,由患者评估鼻堵程度和频度。结果等离子组术中出血较对照组明显减少,术后疼痛和鼻堵程度较轻。术后1个月等离子组和对照组的鼻堵程度、鼻堵频度和下鼻甲体积较术前均有明显改善,二者改善的程度无明显差别。术后3个月两种术式均疗效稳定且等离子组鼻堵频度进一步改善。术后6个月两种术式疗效依然稳定。结论等离子下鼻甲部分消融术创伤小,术中、术后出血少,痛苦小;术后1个月患者主观症状与客观体征均有明显改善;术后3个月患者主观症状进一步改善;术后6个月内疗效均稳定且与吸切钻下鼻甲部分切除术疗效相当。     

Olfactory changes at threshold and suprathreshold levels following septoplasty with partial inferior turbinectomy

Partial inferior turbinectomy with septoplasty is routinely carried out for airway obstruction. However, its effects on the sense of smell have not been systematically evaluated. The aim of this prospective study was to evaluate the influence of septoplasty with partial inferior turbinectomy on threshold and suprathreshold olfactory acuity. The subjects were 30 patients undergoing septoplasty including partial inferior turbinectomy. Olfactory function was determined by the "Sniffin' Sticks," which allow the assessment of odor thresholds, odor discrimination, and odor identification. The patients rated both olfactory function and nasal airflow using visual analog scales. Nasal airflow was measured by anterior rhinomanometry. Multivariate analyses of variance for repeated measures were used to analyze the results before and after surgery (mean interval, 9.1 weeks). After operation, 87% of the patients had increased airflow, 80% had improved olfactory function in terms of odor identification, and in 70% odor discrimination was found to be improved - but only 54% had improved olfactory function in terms of odor thresholds. Surgery increased ratings of nasal airflow in 93%, and those of olfactory function in 77% (p < .001). Similarly, bilateral inspiratory nasal flow increased (p < .001) and olfactory function was improved (p < .001) after surgical treatment. However, this increase was most pronounced for suprathreshold tests, while it was moderate for odor thresholds (interaction "surgery" x "olfactory test," p = .001). The present investigation suggests that septoplasty in combination with inferior turbinectomy has a beneficial effect on olfaction, mainly on suprathreshold olfactory functions. This effect may be partly due to interactions between the increased perception of nasal airflow and cognitive factors involved in olfactory sensitivity. According to the present results and data from the literature, a moderate decrease of olfactory function appears to occur in as many as 20% of patients. However, anosmia seems to be an extremely rare complication of septoplasty and partial turbinectomy.     

下鼻甲手术方式的选择

目的 :探讨下鼻甲手术的最佳方式 ,进一步明确常用术式的适应证。方法 :采用 5种下鼻甲术式对97例慢性肥厚性鼻炎或下鼻甲代偿肥大的患者行手术治疗 ;检测手术前后的鼻阻力的变化。结果 :5种术式中 ,下鼻甲部分切除术疗效好 ,但术后反应大 ,易并发出血及术后鼻腔干燥感 ;功能性下鼻甲手术疗效较好 ,术后反应轻、恢复快。结论 :5种下鼻甲术式均有明确的适应证 ,但功能性下鼻甲手术适应证较广 ,疗效确切     

电动鼻窦切割钻和微波切除部分下鼻甲对鼻黏膜纤毛清除系统的影响

目的：探讨电动鼻窦切割钻（HUMMER）和微波切除部分下鼻甲对鼻黏膜纤毛清除系统的影响,为临床选择合理术式提供理论依据。方法：HUMMER切除部分下鼻甲组（HUMMER组）和微波切除部分下鼻甲组（微波组）各20例,无鼻腔疾病的健康对照组10例。每例患者分别于术前、术后3个月和术后6个月取材,健康对照组任选5例取材。每次取每个研究对象的下鼻甲黏膜,分别行光镜和扫描电镜观察。所有患者取材之前用糖精试验测定鼻黏膜纤毛输送率（MTR）。结果：①HUMMER组术前、术后3个月和术后6个月MTR分别为（3．63±0．57）、（3．76±0．43）、（6．09±1．19）mm／min,术后6个月与术前、术后3个月比较差异均有统计学意义（均P〈0．01）。微波组术后3、6个月MTR分别为（3．96±0．40）和（3．95±0．32）mm／min,与健康对照组（6．20±0．68）mm／min比较差异均有统计学意义（均P〈0．01）。微波组术后6个月与HUMMER组术后6个月MTR比较差异有统计学意义（P〈0．01）。②光镜及扫描电镜观察：HUMMER组和微波组术前鼻黏膜上皮内杯状细胞增多,纤毛排列紊乱、缺失,粗细长短不一,部分黏膜上皮由假复层纤毛柱状上皮化生为单层立方上皮;HUMMER组术后鼻黏膜上皮再生为假复层纤毛柱状上皮,基本和正常黏膜纤毛系统表现一致。微波组术后鼻黏膜纤毛上皮很少再生,黏膜上皮化生为鳞状上皮,纤毛断裂缺失较重。结论：HUMMER切除部分下鼻甲术在保护和恢复鼻腔功能方面优势比较明显。     

中下甲部分切除术治疗血管运动性鼻炎

目的评价中下甲部分切除术治疗血管运动性鼻炎(VR)的临床效果.方法将126例VR患者随机分成3组,每组42例,A组行双侧中下甲黏膜激光烧灼;B组行筛前神经和翼管神经电灼术;C组行中下甲部分切除术.合并鼻中隔偏曲者同时行鼻中隔黏膜下切除术.术后1个月、半年、1年和5年各随访1次,比较3组术后症状,术后并发症和复发率.结果3组患者术后症状均消失.但随着随访时间的延长,均有部分病例复发.术后1～6个月复发者以A、B两组较多,差异无显著性,术后1～5年,A、B两组复发率达80%～90%,复发后的症状评分与术前相同.而C组术后近期复发率低(术后6个月为4.76%),5年后随访复发率为26.19%,复发者症状评分(5.18±1.07)明显低于手术前(8.46±1.38).结论中下甲部分切除术治疗VR效果好,复发率低,并发症少,且手术操作简单,是目前治疗VR的最佳手术方案.     

动力系统两种刀头行下鼻甲部分切除术的比较

目的比较动力系统下用下鼻甲刀头行下鼻甲黏膜下切除术与用筛房刀头行下鼻甲部分切除术的优缺点.方法91例用筛房刀头行下鼻甲部分切除术(筛房刀头组),45例用下鼻甲刀头行下鼻甲黏膜下切除术(下鼻甲刀头组),比较2组术中出血量,手术时间,早、中期疗效,术后痂皮量及去除快慢、术后并发症等.结果筛房刀头组手术出血量多,手术时间短,中期疗效好,术后并发症稍多;下鼻甲刀头组手术出血少,患者痛苦轻,术后痂皮少,很快改善了鼻塞症状(术后1周总有效率64.4%),无并发症.但中期疗效(术后半年总有效率为77.8%)不及筛房刀头组(术后半年总有效率为94.5%),两者差异有显著性(χ2=10.39,P<0.01).结论两种手术方法各有优缺点,筛房刀头组中期疗效好于下鼻甲刀头组.     

下鼻甲骨粘骨膜下部分切除术60例报告

目的评估下鼻甲骨粘骨膜下部分切除术治疗慢性鼻炎的疗效,结合病理检查探讨下鼻甲骨在慢性鼻炎发病机制中的作用.方法回顾分析60例下鼻甲骨粘骨膜下部分切除术治疗慢性鼻炎的临床资料及随访资料.结果60例下鼻甲骨粘骨膜下部分切除术治疗慢性鼻炎,疗效满意,无严重并发症发生.结论下鼻甲骨粘骨膜下部分切除术是治疗慢性鼻炎安全、有效的方法;下鼻甲骨在慢性鼻炎发病机制中起一定的作用.     

Pneumatization of the concha inferior as a cause of nasal obstruction

Chronic nasal obstruction is a common disorder. Hypertrophy of the inferior turbinates is responsible for nasal obstruction more frequently than it is commonly thought. A pneumatized inferior turbinate has recently been described as a cause for nasal obstruction and only two cases have been reported until now. Inferior nasal turbinate develops by endochondral ossification of components of the mesethmoid and ectethmoid. The chondral framework of the inferior turbinate consists of a double lamella and two separate ossification centers that develop between the fifth and seventh month of fetal life. The separate ossification centers meet by the eighth fetal month. During ossification, the inferior turbinate detaches from the ectethmoid and becomes an independent bony structure. During that time the epithelium may misinvaginate into double lamellas and such double lamellas formed by the inferior turbinate may become persistent. A patient was referred to our clinic with headaches and nasal obstruction. A CT scan was performed which showed that the right lower concha was pneumatized. The headache of the patient disappeared after partial resection of the lower and middle turbinate.     

Changes in olfactory acuity induced by total inferior turbinectomy

The short-term and long-term effects of total inferior turbinectomy on smell acuity was assessed in two groups of patients. Olfactory thresholds were determined by a three-way forced-choice method, using four odorants. Resection of obstructive inferior turbinates resulted in a decrease in olfactory thresholds in 22 of 24 tested patients. No deleterious effect on smell acuity was observed in 16 patients tested 2 1/2 years or more after surgery. Subjective assessment of olfactory acuity is unreliable. It is our intention to focus attention on an aspect of intranasal surgery not frequently reported.