Partial middle turbinectomy by nasotracheal intubation

Partial middle turbinate avulsion is a rare complication of nasotracheal intubation. Patients usually experience a brisk hemorrhage at the time of injury. Postoperatively, some patients develop a unilateral nasal obstruction, while others are asymptomatic. We present an unusual case in which a patient became symptomatic many years after the incident. We hope to raise awareness that a traumatic disruption of the turbinates secondary to nasotracheal intubation might lead to the development of an abnormal nasopharyngeal mass.     

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.     

Comparative evaluation of middle meatus antrostomy with or without partial middle turbinectomy

A considerable controversy surrounds the advisability and efficacy of middle turbinate resection in endoscopic sinus surgery. Some are in favor of middle turbinate preservation considering it to be important anatomic and physiological structure and others advocate middle turbinate resection as it improves nasal air flow and decreases synechiae formation. So a study was undertaken to evaluate the efficacy of middle turbinate resection in patients of chronic sinusitis undergoing Functional Endoscopic Sinus Surgery (FESS). 40 patients of chronic sinusitis were selected and divided into 2 groups, group I undergoing FESS with middle turbinate preservation and group II undergoing FESS along with middle turbinate resection. Final results were recorded 6?months after the operative procedure. 50% patients had relief in nasal obstruction in group I as compared to 88% in group II. Postoperative synechiae formation was seen in five patients in group I and in one patient in group II.     

鼻内镜下中鼻甲部分切除对嗅觉功能的影响

自开展鼻内镜手术以来，涉及中鼻甲对嗅觉影响的报道较少。中鼻甲自身是否存在嗅神经上皮细胞没有最终确认，中鼻甲部分切除对嗅觉的影响没有定论。本研究目的是探讨鼻内镜下中鼻甲部分切除后对其嗅觉功能的影响。     

Clinical effects of submucosal middle turbinectomy for eosinophilic chronic rhinosinusitis

Objective

The preservation or resection of the middle turbinate (MT) during endoscopic sinus surgery (ESS) currently remains a matter of debate. The present study aimed to investigate the effects of submucosal middle turbinectomy (SMT) in ESS for eosinophilic chronic rhinosinusitis (ECRS).

中鼻甲部分切除术对额窦的影响

目的：探讨鼻内窥镜手术中行中鼻甲部分切除对额窦的影响。方法：对８７例鼻内窥镜手术患者的资料进行分析。结果：５５例鼻窦炎（无额窦炎）患者,功能性鼻窦内窥镜手术（ＦＥＳＳ）中,２９例行中鼻甲部分切除,术后７例出现额窦炎;２６例术中未行中鼻甲部分切除者５例出现额窦炎。经统计学处理,两者无显著性差异（Ｐ〉０．０５）。３２例无鼻窦炎患者中,无论行中鼻甲部分切除与否,无一例术后发生额窦炎。结论：中鼻甲部分切除     

修正性鼻内镜手术联合中鼻甲切除术综合治疗难治性鼻-鼻窦炎

目的探讨修正性鼻内镜手术联合中鼻甲切除术综合治疗难治性鼻一鼻窦炎的手术效果及应用价值。方法35例难治性鼻一鼻窦炎经CT检查、鼻内窥镜检查、局部用药等规范术前准备,行改良鼻丘径路额窦开放为主修正手术加中鼻甲全部或部分切除,术后凭鼻内镜保健手册进行定期复查,规范随访。26例合并鼻中隔偏曲者其中16例行内镜下传统矫正切除,10例行局限性矫正切除;15例合并变应性鼻炎者对下鼻甲前端、中鼻甲对应鼻中隔等部位黏膜电凝。结果35例患者门诊内镜随诊3～6月以上,治愈11例（31．4％）,黏膜完全上皮化;好转18例（51．4％）,黏膜可以上皮化,但变应性鼻炎发作时,术腔黏膜水肿,经局部处理及药物治疗后可恢复上皮化;无效6例（17．2％）。总有效率82-8％,6例无效均为合并变应性鼻炎及哮喘患者。结论修正性鼻内镜手术联合中鼻甲切除术综合治疗难治性鼻鼻窦炎,疗效较为确切,值得临床推广。     

中鼻甲成形对鼻窦炎治愈率影响的研究

目的探讨鼻内窥镜手术过程中中鼻甲前缘与上颌窦额突、中鼻甲下缘与下鼻甲上缘的最适距离,以进一步提高鼻窦炎的治愈率.方法将156例患者分为A组,即中甲未处理组,B组,即中甲成形组,C组,即中甲缺失组,进行术后疗效分析.结果A、B2组治愈率分别为53.33%和84.88%(P＜0.01),C组治愈率为45.00%,与B组差异有高度显著性(P＜0.01).结论通过3组比较表明,术中按中甲前缘与上颌窦额突、中甲下缘与下鼻甲上缘的距离≥5mm行中甲成形术,可明显提高治愈率.     

鼻内镜下中鼻甲功能性部分切除治疗慢性鼻窦炎76例分析

目的 观察鼻内镜手术中鼻甲功能性部分切除对于有中鼻甲病变的慢性鼻窦炎伴鼻息肉患者的疗效。 方法 2014年1月至2017年1月收治的76例慢性鼻窦炎伴鼻息肉患者行功能性鼻内镜手术。依中鼻甲有无病变及是否行中鼻甲切除分为观察组(n=38)与对照组(n=38),观察两组手术时间、疗效、中鼻甲粘连和术后主观症状评分。 结果 观察组手术时间为(50.53±6.25)min、对照组为(58.11±6.09)min,差异有统计学意义(t=5.355, P<0.001);术后随访6个月,两组患者治疗有效率均为100%,其中对照组的治愈率为78.95%(30/38),观察组为81.58%(31/38),差异无统计学意义(P>0.05);术后中鼻甲粘连率(χ2=4.155, P=0.042)和主观症状评分差异有统计学意义(Z=3.68, P=0.031)。 结论 对有中鼻甲病变的慢性鼻窦炎伴鼻息肉患者实施鼻内镜手术时行功能性部分中鼻甲切除,能明显缩短患者手术时间、减少中鼻甲粘连率、改善患者的主观症状。     

Epistaxis after partial middle turbinectomy: the role of sphenopalatine artery ligation

Purpose

Extensive nasal polyposis could involve the middle turbinate inducing the surgeon to partially remove it. We initiated this retrospective study to evaluate the effect of a partial middle turbinectomy (PMT) on postoperative epistaxis and if sphenopalatine artery ligation (SPAL) could reduce the risk of bleeding in patients without nasal packing.

Material and Methods

Twenty-seven patients with extended bilateral nasal polyposis and submitted to primary functional endoscopic sinus surgery (FESS) with PMT on 40 sides were retrospectively selected. Postoperative bleeding and other complications were evaluated and compared with those of a control group of 27 patients who underwent FESS with middle turbinate preservation on 40 sides. The study group was furthermore divided into 2 groups according to the execution of SPAL. The incidence of postoperative bleeding of both groups and of the 2 parts of the study group was compared using the Fisher exact test.

Results

A SPAL was necessary to stop intraoperative bleeding in 21 (52.5%) sides of the study group patients and in 7 (17.5%) of the control group patients. After surgery, epistaxis occurred in 8 cases (20%) in the PMT group (1 submitted to SPAL) and in 2 (5%) of the control group. The comparison with the Fisher exact test confirmed the major tendency of postoperative bleeding in the study group and in those not submitted to SPAL (P < .05).

Conclusions

Partial middle turbinectomy causes a higher incidence of postoperative bleeding in patients who are not packed during the FESS operation. The execution of SPAL greatly reduces this risk.     

Inferior turbinectomy in children

BACKGROUND: Inferior turbinectomy on patients of all ages is a controversial procedure. Its effect on children has been reported little in the literature and the few studies that are available involved relatively older children, i.e., >10 years old. Nasal obstruction caused by extensive hypertrophy of the inferior turbinates is not an uncommon observation in the pediatric population. The clinical manifestations might present as snoring, noisy breathing, mouth breathing, and, possibly, sleep apnea. METHODS: In this study, we followed 227 children <10 years of age who underwent inferior turbinectomy (27 children also underwent a revision of an earlier adenoidectomy), of whom 179 children had significant relief of nasal obstruction at the 1-year follow-up. RESULTS: Nocturnal breathing was reported to be more regular and otherwise improved in the 36 children with a suspected history of sleep apnea. Forty-two of 47 children who had thick nasal secretions and did not respond to antibiotic therapy before the operation had significant relief postoperatively. Postoperative complications were few and their number did not exceed that of adults. CONCLUSIONS: A complete inferior turbinectomy should be considered in children <10 years of age who have hypertrophied inferior turbinates that cause major interference with nasal breathing.     

Oropharyngeal foreign body after attempted nasal intubation: a case of traumatic middle turbinectomy

A nasopharyngeal airway, or nasal trumpet, is an adjunctive airway device used to bypass upper airway obstruction at the level of the oral cavity or oropharynx. Although nasal trumpet placement on an awake patient may be uncomfortable, there are no reports of significant trauma from insertion. We present an unusual case of middle turbinate avulsion presenting as a foreign body in the oropharynx after several attempts at placement of a nasopharyngeal airway in an unconscious patient. We hope to raise awareness that nasal intubation in patients with altered consciousness can result in significant nasal trauma, especially after multiple attempts have failed.     

慢性鼻窦炎手术方法的探讨

目的：探讨治疗慢性鼻窦炎的手术方法及中鼻甲前端部分切除术在治疗慢性鼻窦炎中的作用。方法：对87例(155侧)慢性鼻窦炎患者，根据其发病原因及病情不同分为3类，采用相应的手术方法进行治疗。结果：第l类43侧，治愈39侧，好转4侧；第2类8l侧，治愈69侧，好转l0侧，无效2侧；第3类3l侧，治愈17侧，好转9侧，无效5侧。总治愈率为80．6％，有效率为95．5％。结论：对慢性鼻窦炎的手术治疗应因病因、病情不同，采用不同的手术方法，中鼻甲前端部分切除术对治疗慢性鼻窦炎具有重要作用。     

Bipolar scissor turbinectomy: a new technique for day-case turbinectomy

Hypothesis

The study aimed to assess the efficacy of bipolar scissor in the treatment for patients with inferior turbinate hypertrophy.

Materials and Methods

A prospective cohort clinical study was conducted on 10 adult patients who were chosen with a diagnosis of turbinate hypertrophy.

Results

Ninety percent of our cases were satisfied with the procedure, there were significant drops in the sensation of nasal obstruction, the average duration of the procedure was 20 minutes for both sides, and only a single case was complicated with a small burn on the vestibule.

Discussion

Bipolar scissor could be applied safely in turbinate surgery to perform a rapid effective turbinectomy without packing or overnight hospital stay.     

Partial middle turbinectomy during endoscopic sinus surgery for extended sinonasal polyposis: short- and mid-term outcomes

Conclusions. The 23 patients with extensive sinonasal polyposis who had undergone partial resection of the middle turbinate during functional endoscopic sinus surgery (FESS) showed no differences in nasal airway resistance and in postoperative complication rate (1-year follow-up period) in comparison with the 25 patients who had FESS with middle turbinate preservation. Objective. The aim of the study was to investigate the outcomes of partial middle turbinectomy during FESS in patients with sinonasal polyposis. Patients and methods. A retrospective analysis of 48 consecutive patients who had undergone surgery for extended sinonasal polyposis was performed. Twenty-three patients underwent FESS with middle turbinate head resection; 25 patients underwent FESS with preservation of middle turbinate. We endoscopically scored polyposis extension and evaluated nasal airflow resistance (NAR) preoperatively and postoperatively. Results. We found an improvement of endoscopic score (high to low grade of polyposis extension) and a statistically significant reduction of NAR after both surgical techniques. There was no statistically significant difference in the mean NAR values before and after the two techniques.     

Partial middle turbinectomy during endoscopic sinus surgery for extended sinonasal polyposis: short- and mid-term outcomes

CONCLUSIONS: The 23 patients with extensive sinonasal polyposis who had undergone partial resection of the middle turbinate during functional endoscopic sinus surgery (FESS) showed no differences in nasal airway resistance and in postoperative complication rate (1-year follow-up period) in comparison with the 25 patients who had FESS with middle turbinate preservation. OBJECTIVE: The aim of the study was to investigate the outcomes of partial middle turbinectomy during FESS in patients with sinonasal polyposis. PATIENTS AND METHODS: A retrospective analysis of 48 consecutive patients who had undergone surgery for extended sinonasal polyposis was performed. Twenty-three patients underwent FESS with middle turbinate head resection; 25 patients underwent FESS with preservation of middle turbinate. We endoscopically scored polyposis extension and evaluated nasal airflow resistance (NAR) preoperatively and postoperatively. RESULTS: We found an improvement of endoscopic score (high to low grade of polyposis extension) and a statistically significant reduction of NAR after both surgical techniques. There was no statistically significant difference in the mean NAR values before and after the two techniques.