Histopathological verification of clinical indications to partial inferior turbinectomy.

Surgical treatment in cases where disturbances of the nasal patency causes changes in the nasal inferior turbinates is controversial. The authors performed light- and electron microscopy and morphometric examinations of the mucous membrane of the nasal inferior turbinates obtained after partial inferior turbinectomy in patients with vasomotor and perennial allergic rhinitis and compensation hypertrophy of the nasal inferior turbinate accompanied by nasal deviation of the septum. In specimens obtained from patients with vasomotor rhinitis, a small number of glands and fibrosis of the lamina propria was observed. In specimens obtained from perennial allergic rhinitis patients, plenty of glands and large oedema was observed. In the group with compensatory hypertrophy of the inferior turbinate, normal glands and fibred areas around the vessels were observed. The largest histopathological changes of degeneration and hypertrophy of the nasal mucosa were observed in vasomotor rhinitis patients. Histopathological examination of nasal mucosa slides confirmed the usefulness of a partial inferior turbinectomy, but only in vasomotor rhinitis patients.     

Swiftlase inferior turbinoplasty

The hypertrophied inferior turbinates are responsible for nasal obstruction in patients with chronic rhinitis. Several methods have been applied to solve this problem. Recently, laser methods have produced good results. We present the management of 387 patients with hypertrophy of the inferior turbinates mucosa, using CO2 laser in combination with the Swiftlase apparatus. CO2 laser energy delivered through the Swiftlase apparatus provides a char-free ablation of a superficial tissue layer. Swiftlase is easily installed onto the existing CO2 laser units and provides a high-power density. The 1-year postoperative follow-up revealed good results in 261 (81%) of 321 patients, thus establishing CO2 laser in combination with the Swiftlase apparatus as a promising new approach for the management of inferior turbinate hypertrophy. CO2 laser energy delivered through the Swiftlase apparatus offers a treatment modality capable of achieving excellent results in hypertrophy of the inferior turbinates with minimal morbidity.     

Coblation versus microdebrider-assisted turbinoplasty for endoscopic inferior turbinates reduction

ObjectivePatients suffering from persistent inferior turbinates hypertrophy refractory to medical treatments require surgical intervention where the main aim is symptomatic relief without any complications. Extraturbinoplasty is one of the preferred procedures for turbinate reduction due to its efficacy in freeing up nasal space by removing the obstructing soft tissue and bone while preserving the turbinate mucosa. We sought to evaluate the effectiveness and safety of microdebrider assisted turbinoplasty (MAT) and coblation assisted turbinoplasty (CAT) performed as an extraturbinoplasty procedure.MethodsA prospective randomized comparative trial was conducted among patients with bilateral nasal blockage secondary to inferior turbinates hypertrophy. Patients were randomly assigned to MAT or CAT. An extraturbinal medial flap turbinoplasty was performed for both techniques. Symptom assessment was based on the visual analogue score for nasal obstruction, sneezing, rhinorrhea, headache and hyposmia. Turbinate size, edema and secretions were assessed by nasoendoscopic examination. The assessments were done preoperatively, at 1st postoperative week, 2nd and 3rd postoperative months. Postoperative morbidity like pain, bleeding, crusting and synechiae were documented. The clinical outcomes of both techniques were analyzed using repeated measures ANOVA.ResultsA total of 33 participants were recruited, 17 patients randomized for MAT and 16 patients for CAT. Nasal obstruction, discharge, sneezing, headache and hyposmia significantly reduced from 1st week until 3 months for both procedures. Similar significant reductions were seen for turbinate size, edema and secretions. However, there was no significant difference in symptoms and turbinate size reduction were seen between both groups at the first postoperative week, 2nd and 3rd postoperative months. There was significant longer operating time for CAT when compared to MAT (p = 0.001). The postoperative complications of bleeding, crusting and synechiae did not occur in both groups.ConclusionBoth MAT and CAT were equally effective in improving nasal symptoms and achieving turbinate size reduction in patients with inferior turbinate hypertrophy. Both MAT and CAT offer maximal relieve in patients experiencing inferior turbinates hypertrophy by removing the hypertrophied soft tissue together with the turbinate bone without any complications.     

Comparison of microdebrider-assisted inferior turbinoplasty and submucosal resection for children with hypertrophic inferior turbinates

OBJECTIVES: The aim of this study was to compare the effectiveness and safety of microdebrider-assisted inferior turbinoplasty (MAIT) with submucosal resection (SR) for children with hypertrophic inferior turbinates. MATERIALS AND METHODS: One hundred and twenty children with chronic nasal obstruction due to hypertrophic inferior turbinates were enrolled. These children were randomly assigned to receive SR of the inferior turbinate (n=60) or MAIT (n=60). Ten children who did not appear to display any nasal discomfort served as normal controls. Surgical-outcome was evaluated with respect to four distinct parameters: nasal endoscopy, subjective assessment of nasal symptoms by the patient using a visual analogue scale, anterior rhinomanometry, and saccharin test. These evaluations were conducted before surgery and at 1 week, 1 and 3 months after surgery. RESULTS: In the SR group, turbinate edema was decreased significantly at 1 and 3 months after surgery (p<0.05). Nasal secretions and crusting were increased significantly (p<0.05) in the SR group at 1 week after surgery and then decreased significantly at 1 and 3 months after surgery. In the MAIT group, turbinate edema and nasal secretions were decreased significantly at 1 and 3 months after surgery (p<0.05). Nasal crusting was not observed after surgery. Subjective complaints including nasal obstruction, sneezing, rhinorrhea and hyposmia were significantly improved in both groups from 1 month after surgery (p<0.05). Rhinomanometric assessment did not reveal significant improvement until 3 months after surgery in both groups. Saccharin transit time was significantly increased (p<0.05) compared to baseline at 1 week after surgery in the SR group but was not significantly different in the MAIT group. CONCLUSION: MAIT and SR are both effective at relieving nasal obstruction due to the presence of hypertrophic inferior turbinates. MAIT is superior to SR with regard to preserving the nasal mucosa.     

Endoscopic microdebrider-assisted inferior turbinoplasty with and without posterior nasal neurectomy

Objective

Endoscopic microdebrider-assisted inferior turbinoplasty (EMAIT) has been recognized as an efficient surgical technique in the management of hypertrophied inferior turbinate. In an attempt to further increase surgical successful outcomes, posterior nasal neurectomy (PNN) was developed. The aim of this retrospective case–control study was to assess the position of PNN in the surgery of hypertrophied turbinate.

Methods

Seventy patients were assigned to the two treatment groups: Group A (EMAIT) and Group B (EMAIT and PNN). Subjective outcomes were represented by symptom score and quality of life scores (Rhinoconjunctivitis Quality of Life Questionnaire – RQLQ). Objective outcomes were nasal resistance, saccharin transit time and acoustic rhinometry parameters.

Results

The survey demonstrated that symptoms and objective parameters improved postoperatively in both groups, with no statistical significant differences in objective and subjective outcomes between the surgical groups.

Conclusion

The addition of PNN appears to offer no additional benefit in the subjective and objective outcome related with surgery of hypertrophied inferior turbinate. However, longer follow-up studies and larger number of patients are required in order to validate our results.     

The effect of topical 5-flurouracil application post endoscopic inferior turbinoplasty

Rationale and objectives

Adhesions are the most common complication after nasal surgery and revision. 5-Fluorouracil (5-FU) reduces various adhesions and epithelial growth related complications. The aim of this study was to evaluate the effects of 5-flurouracil application in the nasal cavity after a multi-procedure nasal surgery in term of complications frequency.

Comparison of the long term efficacy of radiofrequency ablation and surgical turbinoplasty in inferior turbinate hypertrophy: a randomized clinical study

Objective: To compare the long term effectiveness of radiofrequency thermal ablation with that of surgical turbinoplasty, a prospective, randomized, blinded clinical study was conducted.

Methods: Eighty six patients suffering from nasal obstruction due to bilateral inferior turbinate hypertrophy were enrolled. Forty four patients were operated by radiofrequency ablation, while 42 underwent surgical turbinoplasty. The outcomes of both techniques were compared in terms of symptoms using visual analogue score (VAS) and endoscopic scores.

Results: A statistically significant difference in the VAS scores existed between the two groups by the 3rd month in terms of nasal obstruction (p=.0002) and headache (p=.0001), by the 6th month in terms of nasal secretions (p=.007), by the end of 1 year in terms of sneezing (p=.023) and no statistically significant difference even till the end of year with respect to hyposmia.

Conclusions: Radiofrequency thermal ablation is more effective than surgical turbinoplasty in terms of treating nasal obstruction and equally effective in terms of managing sneezing. Radiofrequency ablation has the advantage of being a day care procedure and minimal complications.     

低温等离子消融术与下鼻甲成形术治疗慢性鼻炎的对比研究

目的 通过研究低温等离子消融术与下鼻甲成形术术后患者鼻塞改善情况和对鼻腔黏膜纤毛功能的影响,探讨治疗慢性鼻炎更有效的方法。方法 选取慢性鼻炎患者40例,随机分为两组,分别行等离子消融术(A组)与下鼻甲成形术(B组)。术前,术后1周、1个月、3个月分别用VAS评分评价患者鼻腔症状。糖精试验评价术前及术后3个月患者鼻腔黏膜纤毛传送功能。结果 等离子组术中出血、手术时间较下鼻甲成形组明显减少,且术后并发症较少;术后3个月两组患者鼻塞均有明显改善;两种手术方式对鼻腔黏膜纤毛功能无影响。结论 对单纯黏膜肥厚的慢性鼻炎,等离子消融疗效显著;对鼻甲骨质肥厚或形态异常的慢性鼻炎,下鼻甲成形术效果好。     

KTP laser inferior turbinoplasty: an alternative procedure to treat the nasal obstruction

OBJECTIVE: Nasal obstruction resulting from inferior turbinate hypertrophy (ITH) was treated with KTP laser inferior turbinoplasty (KIT). The effectiveness of the procedure was assessed. METHODS: A prospective clinical trial was carried out in King Chulalongkorn Memorial Hospital from October 1, 1998 to September 30, 2000. Forty-eight patients with chronic nasal obstruction underwent KIT. Nasal obstruction was pre- and postoperatively assessed, based on 4-point scale, by the patient and investigator. The scores were compared by paired t-test. The correlation of assessment by the patient and investigator was also demonstrated by weighted kappa test. Pre- and postoperative rhinomanometric evaluations were performed in 29 patients and were compared with paired t-test. RESULTS: Significant reduction of nasal obstruction was obtained from assessment by the patient (P<0.000) and by the investigator (P<0.000). The symptoms of sneezing, itching and rhinorrhea were significantly reduced postoperatively (P<0.000). The cure and improvement rate of nasal obstruction were at 70.8 and 100% (assessed by the patient) and at 77.1 and 100% (assessed by the investigator) respectively, and they showed a moderate correlation (Kw=0.65). Rhinomanometrically, the total airway resistance decreased but of not statistic significance (P=0.219), however, the inspired nasal airflow at 150 Pa and the volume of nasal cavities were significantly increased (P<0.00 and P<0.001, respectively). CONCLUSION: KIP was shown to effectively reduce the symptom and sign of nasal obstruction as well as other nasal symptoms without any significant complications. It should be an alternative method in treating the patients with nasal obstruction resulting from hyperplastic inferior turbinate.     

A randomised trial comparing the subjective outcomes following septoplasty with or without inferior turbinoplasty

AimsThe surgical management of contralateral inferior turbinate hypertrophy in patients with deviated nasal septum is controversial. In this randomised clinical trial, we aimed to investigate the subjective improvement of nasal symptoms postoperatively in patients undergoing septoplasty with or without inferior turbinoplasty.Material and methodsOne hundred and thirty-seven patients with nasal obstruction, who had unilateral septal deviation and compensatory contralateral inferior turbinate enlargement, were randomised into either septoplasty alone arm (n = 66) or septoplasty combined with turbinoplasty arm (n = 71). Preoperative symptom scores and the subjective perception of the nasal obstruction were compared between two groups of the study using Nasal Obstruction Symptom Evaluation Scale (NOSE) and Visual analog scale (VAS) respectively. The measurements were repeated 6 months after surgery as well as at 1, 2, and 4 years postoperatively.ResultsWith regard to the findings obtained from both scales, both interventions successfully relieved the patients’ complaints of nasal obstruction at almost all postoperative visits when compared with the baseline measurements (P ˂ 0.005 for most comparisons). However, the relief of nasal obstruction was more pronounced in patients undergoing combined intervention at all postoperative visits, except at the 1st follow-up session (P ˂ 0.005). Nasal symptoms of septoplasty alone group began to deteriorate over the period between month 24 and month 48. In contrast, patients undergoing the combined surgery steadily showed symptomatic improvement over the whole period of study.ConclusionsA turbinate reduction surgery should be conducted along with septoplasty to achieve better results in cases suffering from deviated nasal septum with concomitant hypertrophied inferior turbinate.     

Long-term efficacy of microdebrider-assisted inferior turbinoplasty with lateralization for hypertrophic inferior turbinates in patients with perennial allergic rhinitis

Objectives: The aim of the study was to evaluate the long‐term efficacy of microdebrider‐assisted inferior turbinoplasty with lateralization (MAITL) compared to submucosal resection for hypertrophic inferior turbinates. Study Design: Surgical outcomes were evaluated with respect to visual analogue scale, anterior rhinomanometry, and saccharin test results. Methods: From January 2002 to December 2006 inclusively, 160 patients with perennial allergic rhinitis and hypertrophic inferior turbinates were enrolled into this study. The patients, all suffering from chronic nasal obstruction, were randomly classified into two groups, MAITL group or SR group, each comprised of 80 patients. Ten patients who did not display any nasal discomfort served as normal controls. For the submucosal resection group, patients underwent submucosal resection of the inferior turbinate, whereas patients in the MAITL group underwent microdebrider‐assisted inferior turbinoplasty with lateralization. Assessments (visual analogue scale, anterior rhinomanometry, and saccharin test) were conducted prior to the surgery and 1, 2, and 3 years after completion of surgery. Results: Compared to preoperative values, subjective complaints including nasal obstruction, sneezing, rhinorrhea, and snoring improved significantly in both groups at 1, 2, and 3 years after surgery in both groups (P < .05 for all). Rhinomanometric assessment also showed significant improvement at 1, 2, and 3 years postoperatively in both groups (P < .05 for all). Saccharin transit time was significantly decreased (P < .05 for all) compared to preoperative values 1, 2, and 3 years after surgery in both groups. Conclusion: Microdebrider‐assisted inferior turbinoplasty with lateralization appears to be as effective as submucosal resection at relieving nasal symptoms and decreasing total nasal resistance and saccharin transit times for more than 3 years in patients with perennial allergic rhinitis who have had substantial nasal obstruction.     

Effects of turbinoplasty versus outfracture and bipolar cautery on the compensatory inferior turbinate hypertrophy in septoplasty patients

IntroductionThe most common cause of septoplasty failure is inferior turbinate hypertrophy that is not treated properly. Several techniques have been described to date: total or partial turbinectomy, submucosal resection (surgical or with a microdebrider), with turbinate outfracture being some of those.ObjectiveIn this study, we compared the pre- and postoperative lower turbinate volumes using computed tomography in patients who had undergone septoplasty and compensatory lower turbinate turbinoplasty with those treated with outfracture and bipolar cauterization.MethodsThis retrospective study enrolled 66 patients (37 men, 29 women) who were admitted to our otorhinolaryngology clinic between 2010 and 2017 because of nasal obstruction and who were operated on for nasal septum deviation. The patients who underwent turbinoplasty due to compensatory lower turbinate hypertrophy were the turbinoplasty group; Outfracture and bipolar cauterization were separated as the out fracture group. Compensatory lower turbinate volumes of all patients participating in the study (mean age 34.0 ± 12.4 years, range 17–61 years) were assessed by preoperative and postoperative 2 month coronal and axial plane paranasal computed tomography.ResultsThe transverse and longitudinal dimensions of the postoperative turbinoplasty group were significantly lower than those of the out-fracture group (p = 0.004). In both groups the lower turbinate volumes were significantly decreased (p = 0.002, p < 0.001 in order). The postoperative volume of the turbinate on the deviated side of the patients was significantly increased: tubinoplasty group (p = 0.033).ConclusionBoth turbinoplasty and outfracture are effective volume-reduction techniques. However, the turbinoplasty method results in more reduction of the lower turbinate volume than outfracture and bipolar cauterization.     

Patients with positive allergen test have less favorable outcome after endoscopic microdebrider-assisted inferior turbinoplasty

BACKGROUND: Endoscopic microdebrider-assisted inferior turbinoplasty is a newly developed surgical technique to treat patients with nasal obstruction. Although the procedure has been reported to be safe and effective, we tested the hypothesis that the prognosis might deteriorate with time in allergic rhinitis patients as identified by a positive allergen test in patients who have a persistent regional inflammation of the nose. We assessed the degree of nasal obstruction in a prospective cohort to investigate whether positive allergen test predicts outcome. METHODS: In 70 consecutive patients, the symptom of nasal obstruction was evaluated subjectively by a visual analog scale (VAS) and objectively by acoustic rhinometry using cross-sectional area of the second notch (CSA-2) and nasal cavity volume before operation, and 3 months, 12 months after operation, respectively. Then, patients were classified and compared according to the multiple-antigen simultaneous test (MAST). RESULTS: Both MAST(+) and MAST(-) groups showed statistically significant improvement in VAS score, CSA-2, and nasal cavity volume at 12 months after operation (p < 0.01). Of note, MAST(+) patients showed less favorable results than MAST(-) patients at 12 months after operation (p < 0.05). CONCLUSION: Microdebrider-assisted inferior turbinoplasty provides effective relief for patients with nasal obstruction. However, such turbinate surgery may be successful only for a short period of time in patients with allergic rhinitis. Our finding suggests that, in selecting appropriate candidates, surgeons should consider criteria other than symptomatology, especially in patients with allergic rhinitis who may have manifestations other than at the level of the inferior turbinate contributing to nasal blockage.     

下鼻甲黏膜病理及超微结构观察

目的探讨慢性鼻炎下鼻甲黏膜组织病理及超微结构特征性改变。方法收集38例慢性鼻炎病例标本,其中慢性单纯性鼻炎12例;慢性肥厚性鼻炎26例,其中6例行下鼻甲手术。每例患者分别切取下鼻甲黏膜2块依次送病理及超微结构检查。结果病理及超微结构显示下鼻甲黏膜上皮不同程度脱落、间质炎细胞浸润、纤毛结构不同程度缺损等共同特点。慢性单纯性鼻炎间质腺体增生,血管扩张,炎细胞浸润,伴急性炎症者可见中性粒细胞;慢性肥厚性鼻炎间质以淋巴细胞和浆细胞浸润为主,黏膜上皮脱落化生,间质纤维增生;下鼻甲黏膜下手术患者纤毛结构保护较好。结论慢性单纯性鼻炎和慢性肥厚性鼻炎有不同特征性组织病理及超微结构所见,下鼻甲黏膜下手术是治疗慢性肥厚性鼻炎理想手术方式。