Ho:YAG laser treatment of hyperplastic inferior nasal turbinates.

OBJECTIVES: Although preliminary studies about the successful use of the Ho:YAG laser in nasal turbinate surgery have been reported, no clinical study has been performed on this procedure. The aim of this prospective clinical study was to assess the long-term effect of Ho:YAG laser in the treatment of hyperplastic inferior nasal turbinates. METHODS: Eighty-five patients with nasal obstruction who did not respond to conservative medical treatment were treated with a pulsed Ho:YAG laser (wavelength of =2080 nm). Fifty-two of these patients were included in this clinical study and were followed for 1 year. RESULTS: Within the first 2 weeks, nasal obstruction was correlated to the extent of nasal crusting. Six months after laser treatment, the mucociliary function test showed no variation compared with the preoperative measurements. One year after laser treatment 77% of the patients demonstrated improved nasal airflow on rhinomanometry and questionnaire. CONCLUSIONS: Ho:YAG-laser treatment of hyperplastic turbinates can be performed as outpatient surgery under local anesthesia and offers controllable ablation of soft tissue in a short operation time with satisfactory results and excellent patient acceptance.     

Long-term comparison between submucosal cauterization and powered reduction of the inferior turbinates

OBJECTIVES/HYPOTHESIS: To evaluate the results of powered turbinoplasty and to compare these with submucosal cauterization of the inferior turbinates. STUDY DESIGN: Prospective, randomized, comparative surgical trial. METHODS: Nineteen patients with medication-resistant chronic nasal obstruction caused by inferior turbinate hypertrophy were randomized to undergo powered turbinoplasty on one side and submucosal cauterization on the other. For each side, an extensive assessment (symptom scoring, endoscopic scoring, and acoustic rhinometry) was recorded preoperatively and on week 1, week 3, month 3, year 1, and year 5 postoperatively. RESULTS: Powered turbinoplasty was superior to submucosal cauterization on all aspects of the assessment. A significant difference (P < .05) was noted for postoperative crusting, endoscopical scoring of turbinate size, and acoustic rhinometry measurements of nasal cavity volume and mean area at the level of the nasal valve. In addition, the results of powered turbinoplasty were still apparent on long term follow-up, whereas submucosal cauterization was associated with a recurrence of turbinate hypertrophy. CONCLUSION: Performing a powered turbinoplasty leads to decreased patient morbidity during the postoperative healing and to a better control of long-term results when compared with submucosal cauterization.     

Impact of resection of the turbinates and the lateral nasal wall on particle deposition

OBJECTIVES/HYPOTHESIS: The aim of the investigation was to determine the influence of complete resection of the turbinates and the lateral nasal wall on nasal deposition of particulate matter with an aerodynamic diameter of 10 microm or less (pm10) and its relation to nasal patency and geometry. STUDY DESIGN: Retrospective study. METHODS: Eight patients were enrolled in the study after unilateral sinus surgery for a unilateral inverted papilloma of the sinuses. Particle deposition from the inhaled and exhaled air was measured by means of a laser particle counter in the nasal valve area and the nasopharynx during nose-only breathing and nose-in, mouth-out breathing. The data on deposited fraction for the operated side were compared with the data for the untreated, healthy side. Rhinomanometry and acoustic rhinometry were performed. RESULTS: Particle deposition did not differ significantly between the operated and untreated sides of the nose at both detection sites. No correlation between the deposited fraction and rhinomanometric and rhinometric values was found. CONCLUSION: Radical resection of the turbinates does not seem to disturb particle deposition (pm10) measured in the nose to a significant degree. Factors other than impaction and sedimentation onto the mucosal surface of the turbinates seem to be sufficient for effective particle deposition after radical removal of the turbinates.     

Long-term results after argon plasma coagulation (APC) inferior turbinates reduction

Interior turbinate hypertrophy is one of the major causes of nasal airway obstruction. Medical treatment often produces insufficient improvements. In these cases, surgical reduction of inferior turbinates can be proposed. Authors analyzed long-term results of argon plasma coagulation (APC) for inferior turbinates reduction in patients with chronic nasal obstruction. Rhinomanometric parameters, clearance of saccharine test results and cytological examination were statistically analyzed in 70 patients after 3 month and in 47 after 12 month after surgery. Five patients received a second operation. Only patients with first degree in T/S (turbinate/septum) nasal septum deviation were enrolled in both groups. Every patients were treated ineffectively with nasal drops. All patients received topical anesthesia. The procedure of APC were easy to perform end we did not experience postoperative bleeding. Rhinomanometric measurement demonstrated a significant nasal flow at 3 and 12 month after APC. Before 3 and 12 month after surgery the values for resistance shoved significant difference. There were no changes in saccharine transit - time during the follow-up period. At 3 postoperative month, the nasal stuffiness had improved 62 (88%) patients. At 12 month after surgery, the nasal stuffines had improved 34 (73%) patients. APC was shown to effectively reduce the symptom of nasal obstruction without any complications. Argon Plasma Coagulation should be an alternative method in treating the patients with hyperplastic inferior turbinate.     

Long-term results of inferior turbinate reduction with argon plasma coagulation

OBJECTIVES: Surgical reduction of the inferior turbinates is a commonly used therapy in patients with hyperplastic inferior turbinates when medical management remains ineffective. Current surgical methods have disadvantages (e.g., necessity of nasal packing, extended postoperative swelling, and high costs). Theoretical considerations render argon plasma coagulation (APC) a promising new therapeutic approach. STUDY DESIGN: In a prospective study, 121 patients with chronic nasal obstruction were treated for inferior turbinate reduction with APC. Hyperplasia of the nasal turbinates was diagnosed rhinoscopically and endoscopically and confirmed rhinomanometrically. The mean follow-up period was 12 months, ranging from 10 to 16 months. The treatment results were evaluated by a questionnaire, rhinomanometric findings, and electron microscopic studies of the nasal mucosa. In 50 patients a ciliary function test was performed preoperatively and postoperatively. METHODS: Argon plasma coagulation, a high-frequency electrosurgery, has been used for volume reduction of the inferior turbinate in local anesthesia. RESULTS: Seventy-six percent of the patients reported an improvement of the postoperative swelling within the first week. After 6 weeks, macroscopically the turbinates were re-epithelialized by normal mucosa in 63% of the patients. Electron microscopic studies after 3 months verified normal cilia. After 12 months, 83% of the patients stated that they had a better nasal airflow than preoperatively. Crust formation was minimal. No bleeding or impaired ciliary function occurred. Ninety-five percent of the patients were willing to undergo the same operation again. CONCLUSION: The long-term results have proved APC to be an effective and easy-to-perform alternative for inferior turbinate reduction with comparable results to other established surgical methods.     

Submucosal bipolar radiofrequency thermal ablation of inferior turbinates: a long-term follow-up with subjective and objective assessment

OBJECTIVE: To assess the efficacy and morbidity of bipolar radiofrequency thermal ablation of the inferior turbinates in patients with nasal obstruction caused by turbinate hypertrophy. STUDY DESIGN: Prospective, nonrandomized study and outpatient treatment. METHODS: Twenty patients (age range, 23-77 y; median age, 52 y) enrolled in the study. There was one dropout. All the patients had nasal blockage despite medical treatment. Bipolar radiofrequency thermal ablation was delivered to inferior turbinates at 100 kHz with a voltage root mean square value of 168 to 182. The preoperative and postoperative nasal functions were investigated by immediate and long-term visual analogue scale (VAS) scores of symptom parameters, olfactory thresholds, saccharine transit time, rhinomanometry, and acoustic rhinometry. The follow-up was conducted at 1 week and 3, 6, and 12 months. RESULTS: The VAS scores of subjective complaints (nasal discharge, itching, sneezing, crusting) decreased, and the VAS scores of evaluation of the effectiveness (frequency of nasal obstruction, degree of nasal obstruction, and patient satisfaction) increased statistically significantly in the 12-month follow-up without relapses. There were no adverse effects on nasal epithelial clearance time and olfactory functions. In rhinomanometry the changes in total nasal resistance and response to the vasoconstrictor agent were not statistically significant. In acoustic rhinometry the change in the sum of both nasal cavity volumes from nostril to 5 cm was statistically significant 6 and 12 months after the treatments. The difference between the preoperative and postoperative vasoconstrictive effect was not statistically significant. CONCLUSION: The bipolar radiofrequency thermal ablation of inferior turbinates is a promising alternative, which should be considered when planning inferior turbinate interventions.     

下鼻甲神经分布研究

目的：通过尸头解剖明确下鼻甲神经分布情况,为选择性切断支配下鼻甲神经治疗变应性鼻炎提供解剖基础。方法：4％多聚甲醛固定成人尸头标本20例（40侧）,从正中矢状位锯开,在10倍手术显微镜下解剖下鼻甲。结果：①鼻后下神经在黏膜和骨膜之间下行由下鼻甲附着处末端前方6～13mm处进入下鼻甲黏膜下,另有分支通过下鼻甲附着处末端进入下鼻甲黏膜下。②筛前神经在下鼻甲附着处上缘距前端2．0～4．6mm进入下鼻甲黏膜下。结论：鼻内镜下选择性地切断支配下鼻甲的神经支配是可行的。     

Radiofrequency tissue ablation of the inferior turbinates using a thermocouple feedback electrode

OBJECTIVE: The objective of this clinical trial was to assess the safety and efficacy of radiofrequency (RF) tissue ablation of the inferior turbinates in the treatment of nasal obstruction using an RF energy delivery system with a thermocouple feedback electrode. METHODS: A prospective, nonrandomized study of 11 patients (mean age, 47+/-12 y) with chronic nasal obstruction was conducted. Using patient-based visual analogue scales (VAS), symptom parameters were assessed. These included degree of nasal obstruction, frequency of nasal obstruction, and pain. Physician assessment of nasal obstruction was also collected by the principal investigator. Follow-up was conducted at 24 hours, 1 week, 4 weeks, 8 weeks, and 1 year. ANOVA was carried out to determine statistically significant differences in the data. Data were fit to a regression model, and confidence intervals were determined from a 95% confidence level. RESULTS: In patient-assessed degree of nasal obstruction, statistical significance was seen among baseline and 4 weeks, 8 weeks, and 1 year (P<.001, P<.0001, and P<.0008, respectively). There was no difference between 8 weeks and 1 year (P<.15). The data appeared to follow an exponential decay to a constant value. The pretreatment baseline average degree of obstruction was 7.5+/-0.5 on a scale of 0 to 10. The degree of obstruction after 8 weeks was 2.7+/-0.6. The time constant for this change was 21 days to reach 90% of the final value. At 1 year, degree of obstruction was 3.3+/-0.7. For frequency of nasal obstruction, statistical significance was seen among baseline and 4 weeks, 8 weeks, and 1 year (P<.0001, P<.0001, and P<.0001, respectively). There was no difference between 8 weeks and 1 year (P<.15). The pretreatment baseline average frequency of obstruction was 7.8+/-0.5. The remaining frequency of obstruction after 8 weeks was 2.9+/-0.6. The time constant was 18 days. At 1 year, frequency of obstruction was 3.3+/-0.6. Physician assessment of nasal obstruction revealed statistical significance among baseline and 4 weeks, and baseline and 8 weeks (P<.0055 and P<.0056, respectively). There was no difference between 4 weeks and 8 weeks (P<.24). The average initial obstruction was 83%+/-4%. The remaining obstruction after 8 weeks was 58% +/-5%. The time constant was 14 days. Mild pain was reported by 55% of patients during the procedure; the remaining 45% reported no pain. Only one patient required pain medication consisting of acetaminophen after the procedure. There were no significant complications. CONCLUSIONS: Degree and frequency of nasal obstruction, as reported by patients, decreased following RF tissue ablation of the inferior turbinates. This improvement in symptoms was still evident after 1 year (P<.001). Physician assessment of obstruction also correlated with patient reports for the initial 8-week study period. The procedure was safe and well tolerated. Thermocouples within the active electrode provided additional feedback to the operating surgeon allowing the use of relatively lower tissue temperatures, power, and energy as compared with traditional techniques. These results support the need for continued research to evaluate this modality as a treatment for chronic nasal obstruction.     

Pleomorphic adenoma originated from the inferior nasal turbinate

Although pleomorphic adenoma is the most common benign neoplasm of the salivary glands, it has also been reported to be present in the neck, ear, mediastinum, external nose and nasal cavity. Intranasal localization of this lesion is very rare and mainly originates from the nasal septum. From wherever the lesion originates, the main treatment modality should be surgical. We presented a very rare case of intranasal pleomorphic adenoma originated from the inferior nasal turbinate. Due to the expansile nature of the lesion, a midfacial degloving approach was preferred.     

鼻内镜下鼻甲成形术疗效分析

目的分析鼻内镜不同下鼻甲成形术的疗效。方法将138例患者随机分为两组,所有患者均同时接受双侧下鼻甲的同一术式处理。A组72例,行双侧下鼻甲骨黏骨膜下骨质部分切除术;B组66例,行双侧下鼻甲骨折外移术。比较两组患者术后1、6及12个月的恢复以及疗效情况。结果两组患者术后12个月疗效具有统计学意义(P<0.01);两组鼻阻塞视觉模拟评分术后6、12个月比较,差异具有统计学意义（P<0.05）,鼻阻力检测术后12个月比较差异具有统计学意义（P<0.05）。A组远期疗效优于B组。结论两种术式都保留了下鼻甲的黏膜以及舒缩功能的血窦组织,在进行有效减容的同时,保留下鼻甲正常的功能, 但从远期效果来看,下鼻甲前端黏骨膜下入路骨部分切除术的疗效明显好于下鼻甲骨折外移术,对于下鼻甲黏膜下组织增生或（和）下鼻甲骨质增生所引起的鼻阻塞均有良好的效果,值得适当放宽手术适应证。     

鼻内镜下下鼻甲骨部分切除术治疗下鼻道出血

目的:探讨鼻内镜下下鼻甲骨部分切除术治疗下鼻道出血的有效性。方法:对21例下鼻道出血患者行鼻内镜下下鼻甲黏骨膜分离、下鼻甲骨骨折后部分切除,局部填塞。术后鼻腔粘连者,分离后放置薄荷石蜡油浸后的明胶海绵,观察疗效。结果:全部患者经过手术填塞后止血满意,3~7 d治愈出院,随访2个月~3年,无复发。结论:鼻内镜下黏骨膜分离及下鼻甲骨部分切除术治疗下鼻道鼻出血是一种有效、可靠的方法。用薄荷石蜡油浸润后的明胶海绵放置隔离预防粘连,简单易耐受,效果好。     

Choanal polyp originated from the inferior nasal concha

Almost all choanal polyps originate from the maxillary sinus and a choanal polyp (CP) originating from the inferior nasal concha (INC) is a rare entity. It presents in a similar manner to the more common antrochoanal polyp and may be confused on anterior rhinoscopy. In this report, an unusual case of a CP taking origin from the INC that was removed by endoscopic endonasal surgery in a young man is presented. No intraoperative or postoperative complication occured, and the symptoms immediately resolved after the operation. Although very rare, CPs arising from the INC should be kept in mind in the differential diagnosis of a solitary nasal polyp.     

Cryosurgery of the inferior nasal turbinates

Forty-seven patients with irreversible nasal obstruction due to inferior turbinate hypertrophy were treated by cryosurgery, the short and medium term results having been clinically evaluated. Permanent good results in nasal breathing were achieved in 83% of the patients. Failures are mostly related to turbinates hypertrophy due to nasal allergy. The combination of cryosurgery and nasal septoplasty, in cases of hypertrophy associated with deformities of nasal septum, gives an excellent result. Cryosurgery of hypertrophic nasal turbinates is a simple, safe, and reliable procedure to improve nasal breathing in cases of nasal turbinate hypertrophy.