Comparison of the effects of radiofrequency tissue ablation,CO2 laser ablation,and partial turbinectomy applications on nasal mucociliary functions

OBJECTIVES: One of the major causes of chronic nasal airway obstruction is disease of the inferior turbinate. However, there is no agreement on how to deal with this problem. Comparison was made of the nasal functions after treatment by radiofrequency tissue ablation, laser ablation, and partial turbinectomy using subjective symptom scores and objective tests. STUDY DESIGN: Prospective, randomized clinical trial. METHODS: The study was conducted on three groups of 45 adult volunteer patients with symptoms and signs of nasal obstruction and stuffiness related to enlarged turbinates. In group A, laser ablation was applied to the inferior turbinate on one side and partial turbinectomy to the inferior turbinate on the other side. In group B, radiofrequency tissue ablation was applied to the inferior turbinate on one side and partial turbinectomy to the inferior turbinate on the other side. In group C, patients who were not treated by any surgical techniques were the control subjects. Clinical examinations, visual analogue scales, rhinomanometry, and isotopic study of nasal mucociliary transport time were used to assess treatment outcomes. RESULTS: At 12 weeks after surgery, the nasal mucociliary transport time results were compared in the same patients. The average time was 25.60 minutes on the side where laser ablation was applied and 11.40 minutes on the side where partial turbinectomy (PT) was applied. In the patients on whom radiofrequency tissue ablation and partial turbinectomy were applied, the average nasal mucociliary transport time was 10.33 minutes on the radiofrequency tissue ablation side, whereas it was 11.33 minutes on the partial turbinectomy side. Rhinomanometric measurements demonstrated a significant decrease in nasal resistances at 12 weeks in both sides in groups A and B. CONCLUSIONS: In the study it was demonstrated that radiofrequency tissue ablation to the turbinate is effective in improving nasal obstruction objectively and in preserving nasal mucociliary function. Laser ablation of the turbinate is effective in improving the nasal obstruction; however, it disturbs the mucociliary function significantly. With the partial turbinectomy technique, results obtained were similar to the results with the radiofrequency tissue ablation technique.     

Time course in the relief of nasal blockage after septal and turbinate surgery: a prospective study

OBJECTIVE: To evaluate prospectively the time course of the change in efficacy of septal and turbinate surgery in relieving nasal obstruction. DESIGN: Interventional study, before-after trial. SETTING: Referral center, institutional practice, hospitalized care. PATIENTS: Thirty-four consecutive patients undergoing septal and turbinate surgery were recruited. Seven patients were unwilling to complete the follow-up after surgery. No patient withdrawal was because of adverse effects. Twenty-five normal subjects with no nasal obstruction were included as control subjects. INTERVENTION: Functional nasal septal and turbinate surgery was performed to relieve nasal obstruction. MAIN OUTCOME MEASURE: Patient assessment of severity of nasal blockage on a 0-mm (no blockage) to 100-mm (maximum blockage) visual analog scale before surgery and at fixed intervals after surgery. RESULTS: The mean nasal blockage scores significantly decreased from the preoperative values at all intervals of follow-up. For the whole group, the nasal blockage score was on average 52% of the preoperative value at the last follow-up. The probability of having at least a 50% reduction in blockage decreased from 73%, to 60%, to 41%, and then to 27% at 3 months, 6 months, 1 year, and 2(1/2) years, respectively. CONCLUSIONS: Improvement in nasal blockage was found in patients after functional septal and turbinate surgery. However, the probability of substantial relief gradually decreased with time. Patients should be followed up after septal and turbinate surgery for possible recurring symptoms.     

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.     

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。     

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.     

Is turbinate surgery necessary when performing a septoplasty?

Many otolaryngologists perform septoplasty with or without turbinate surgery and the surgical method relies largely on the surgeon’s clinical judgment. This study used computed tomography (CT) of the sinuses of 20 patients to examine the correlation between a unilateral deviated nasal septum and compensatory hypertrophy of the contralateral inferior turbinate to suggest guidelines for septal and turbinate surgery. The thickness of the mucosa and conchal bone, the projection angle of the conchal bone, and the distances between the conchal bone, and lateral nasal line and median line were measured. The volume of the inferior turbinate was measured from the three-dimensional reconstruction. Each measurement was compared with those of the nasal cavity on the contralateral and of normal control subjects. The inferior turbinate on the concave side had a significantly greater volume, including the thickness of medial mucosa and the thickness and projection angle of conchal bone. Septoplasty and concomitant inferior turbinate surgery to manipulate conchal bone and soft tissues are necessary for treatment of those patients with unilateral nasal septal deviation and compensatory hypertrophy of the contralateral inferior turbinate.     

鼻内镜下108例鼻腔扩容术疗效分析

目的 探讨鼻内镜下鼻腔扩容术的疗效.方法 选择108例鼻中隔偏曲和慢性肥厚性鼻炎患者,根据具体病情分别行个性化手术,如鼻中隔偏曲行鼻内镜下鼻中隔成形术或三线减张鼻中隔矫正术;慢性肥厚性鼻炎行鼻内镜下下鼻甲外移术酌情联合下鼻甲等离子消融术或下鼻甲黏膜下切除术及下鼻甲部分切除术等.结果 术后随访3～12个月,有效率为97.2%,患者无头痛,鼻干等并发症发生.结论 鼻内镜下鼻腔扩容术处理鼻中隔偏曲和慢性鼻炎疗效确实.

Abstract：

Objective To investigate the efficacy of endoscopic nasal cavity enlarging surgery for the alleviation of nasal obstruction.Methods One hundred and eight patients with deviation of the nasal septum ( DNS) and chronic hypertrophic rhinitis ( CHR) were included in this study.Individualized operations were performed.DNS patients were treated by three line tension relaxing correction or nasal septum plasty.CHR patients were treated by inferior turbinate outfracture in combination with plasma radiofrequency ablation for reducing the volume of nasal soft tissue,sub-mucoperiosteal partial resection of the inferior turbinate or partial inferior turbinectomy.Results All patients were followed for 3-12 months after surgry with an effective improvement in 97.2%.Symptoms of headache or complications of rhinitis sicca were not found.Conclusions Being careful to keep the physiological function of nasal mucosa,the integrity of the nasal septum,appropriate expansion of the nasal cavity volume,and restore ventilation with bilateral symmetry of the nasal cavity,satisfactory relief of nasal obstruction can be achieved.     

Dehiscence of the greater palatine nerve. A risk factor in inferior turbinectomy?

Inferior turbinectomy, often combined with septal surgery, is frequently performed in the surgical treatment of nasal obstruction. A patient with post-operative greater palatine anaesthesia occurring after this procedure prompted a study of the anatomy of the greater palatine nerve in the region of the inferior turbinate. Sixty-four lateral nasal walls were examined in cadavers. A dehiscence rate of 22% was noted, and in an additional 55% there was only a minimal bony covering to the nerve. Dehiscences occurred exclusively in the inferior meatus, anterior to the posterior bony end of the inferior turbinate. The narrow antero-posterior extent of the dehiscence, the hard dense lateral nasal wall bone and the lateral position of the nerve in the canal help to protect the nerve from surgical trauma during turbinate surgery.     

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.     

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.     

Radiofrequency is a safe and effective treatment of turbinate hypertrophy

OBJECTIVE: To evaluate the safety and efficacy of radiofrequency for reduction of inferior turbinate volume. STUDY DESIGN: Prospective before-and-after trial. METHODS: Fourteen patients complaining of chronic nasal obstruction and failing to respond to medical treatment were prospectively enrolled. All patients presented with inferior turbinate hypertrophy and no septal deformity. Radiofrequency inferior turbinate tissue reduction with three punctures in each turbinate (mean energy/puncture: 342 +/- 36 J, mean duration: 69 +/- 17 s, plateau tissue temperature: 75 +/- 6.4 degrees C). Patients were evaluated before and on days 3, 7, and 60 after intervention. RESULTS: No postoperative pain or complications were reported. Evaluation of nasal obstruction, quantified by visual analogue scale, showed a significant decrease of day time and nighttime obstruction after surgery. Acoustic rhinometry measurements showed that turbinate hypertrophy was significantly reduced in the sitting and supine positions on day 60 after surgery. Saccharin transit times decreased significantly on day 60 compared with preoperative measurements. Ciliary beat frequency, measured in vitro in nasal epithelial cells sampled from the inferior turbinate by brushing, was not significantly different before surgery and on day 60 after surgery. In the same samples, ciliated cells were the most abundant epithelial cell type before and after surgery, although in five cases, moderate numbers of squamous cells were detected on either day 7 or day 60 after surgery. CONCLUSION: Radiofrequency is a safe surgical procedure capable of reducing turbinate volume without altering the nasal mucosa, and causing minimal discomfort for the patient.     

Nasal soft tissue obstruction improvement after septoplasty without turbinectomy

The objective of the study was to evaluate the outcome of septoplasty without inferior turbinectomy in patients with septum deviation and nasal obstruction. After exclusion of allergic rhinitis, this study included 30 patients with deviated nasal septum and hypertrophied inferior nasal turbinate who were prepared for septoplasty without turbinectomy. After full history taking and complete otorhinological examination, all patients graded their extent of obstruction using the Nasal Obstruction Symptoms Evaluation scale and underwent CT scans to evaluate the side and shape of deviation, thickness of the medial and lateral mucosa and inferior conchal bone on both the concave and convex sides. Postoperative (PO) follow-up consisted of evaluation of surgical outcome, nasal obstruction grading and patient’s satisfaction. CT imaging was repeated for evaluation of the previous items and to compare with preoperative data. All surgeries were conducted smoothly without intraoperative complications and all were managed as day surgery. The mean duration of follow-up was 20.1 ± 4.4 months. All patients showed progressive significant decline of nasal obstruction symptoms and only eight patients still had mild symptoms. Patients’ satisfaction scores showed significant progressive increase reaching a peak at the 12th month. Preoperative CT confirmed the presence of hypertrophied mucosa on the concave septal side with significantly thicker medial and non-significantly thicker lateral mucosa on the concave side compared to the convex side. At the 12th month PO, mean medial mucosal thickness significantly decreased on the concave side with significant increase on the convex side, but the effect was significantly pronounced on the concave side. Mean lateral mucosal thickness was significantly decreased on the concave and non-significantly increased on the convex side. Conchal bone thickness showed non-significant change despite the diminution on both sides In the absence of allergic rhinitis, septoplasty without turbinectomy significantly improves nasal obstruction-related manifestations and approaches high patient satisfaction with associated reduction of hypertrophied mucosa and spares turbinectomy-related complications.     

Comparative study on the long-term effectiveness between coblation- and microdebrider-assisted partial turbinoplasty

OBJECTIVES: Various surgical methods have been tried to relieve the symptoms of nasal obstruction in patients with inferior turbinate hypertrophy. Recently, coblation that uses the radiofrequency and microdebrider is being increasingly used in turbinate surgery. The aim of this study was to compare the long-term postoperative outcome between the coblation- and microdebrider-assisted partial turbinoplasty. METHODS: We selected 60 patients for this prospective study who had nasal obstruction and hypertrophied turbinate mucosa that was refractory to medical treatment. Thirty patients were treated with coblation (group 1) and 30 patients were treated with microdebrider (group 2). Postoperative changes in degree of nasal obstruction were evaluated prospectively at 3, 6, and 12 months after the procedure. A cross-sectional area of second notch and volume of nasal cavity were compared at 12 months after operation. Operation time, duration of crust formation, postnasal drip, and postoperative bleeding were also compared. RESULTS: Nasal obstruction was improved significantly in both groups at 3, 6, and 12 months after the procedure. However, when compared between two groups, symptom improvement was statistically significant in group 2 at 12 months after surgery. Acoustic rhinometry performed at 12 months demonstrated a significant increase of cross-sectional area of second notch and volume of nasal cavity in group 2 in comparison with group 1. There were no significant differences in degree of postnasal drip, operation time, or duration of crust formation between the two groups. CONCLUSION: This study suggests that microdebrider-assisted partial turbinoplasty is more effective and satisfactory in long-term relief of nasal obstruction and reduction in mucosal volume of anterior head of inferior turbinate.     

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。     

生活质量问卷与鼻声反射测量在下鼻甲肥大不同术式疗效评价中的应用研究

目的　比较下鼻甲黏膜下骨质切除术和骨折外移术治疗下鼻甲肥大的手术疗效。方法　利用生活质量（quality of life,QOL）调查量表和鼻声反射测量对分别接受两种术式的患者进行术前1周和术后12个月的评估。结果　47例下鼻甲肥大患者入选本研究,鼻腔鼻窦结局测试-20（sino-nasal outcome test-20,SNOT-20）量表显示两种术式均使患者获得QOL改善,且术后改善程度相似,下鼻甲肥大患者术前五大问题依次为睡眠质量差、经常需要擤鼻涕、流黏稠鼻涕、容易疲劳、头晕。术后依次为鼻涕倒流、流清水样鼻涕、打喷嚏、注意力不集中、工作效率降低;两种术式均可使患者的鼻声反射测量参数最小横截面积,0～5 cm鼻腔容积（nasal volume,NV）和2～5 cm NV发生显著改变,且黏膜下骨质切除术比骨折外术移获得更宽敞的NV,分别为（7.28±2.01）cm3 vs（6.01±1.22）cm3,（5.99±1.87）cm3 vs（4.23±1.08）cm3（P <0.05）;但SNOT-20得分和鼻声反射测量数值无相关性。结论　针对程度较轻的下鼻甲肥大的患者,推荐下鼻甲骨折外移术作为首选手术方案。     

Effect of submucosal diathermy in chronic nasal obstruction due to turbinate enlargement

Nasal obstruction is one of the most common chronic presenting symptoms encountered by otolaryngologists. In most patients, the cause of nasal obstruction is either nasal septal deviation or turbinate hypertrophy owing to vasomotor or perennial allergic rhinitis. Most cases of hypertrophic turbinate are usually mild and respond to antihistamine therapy, local decongestions, or allergy desensitization; however, surgery is required in some cases. Surgical treatment is controversial, and many surgical methods of treatment have been proposed. We have recently evaluated the results of our experience with submucosal diathermy (SMD) on 51 patients suffering from chronic nasal obstruction. We have found that diathermy demonstrated good results in 78% of the cases at 2 weeks postoperatively and in 76% of the cases 2 months following the procedure. Patients who had no complaints and had good nasal airflow were not followed-up after 2 months. In the present study, we have carried out a long-term follow-up of another group of patients who had undergone SMD diathermy because of hypertrophy of the inferior turbinates. Patients were examined at 2 months postoperatively and after 1 year, with both subjective and objective assessments of nasal breathing. Two months postoperatively 64 of 91 patients (70.3%) experienced subjective improvement in nasal breathing, where as 73 patients (80.2%) had good nasal breathing as indicated with the Gertner-Podoshin plate. During the follow-up year, secondary operations were deemed necessary for 16 patients because of unsatisfactory results of the original procedure. Of these secondary procedures 4 were revision SMD, 9 patients underwent a septoplasty, in 2 patients functional endoscopic sinus surgery was conducted, and 1 patient had a submucosal turbinectomy. This group of patients was excluded from the 1 year follow-up evaluation. At the 1-year follow-up visit, 65 patients (of the 75) were symptom-free with respect to nasal breathing (86.7%), and 67 patients (89.3%) had good nasal breathing as examined with the Gertner-Podoshin plate. No means were apparent for predicting preoperatively which patients would benefit most from submucosal diathermy. Submucosal diathermy is carried out under local anesthesia and can be implemented as an office procedure. It does not require expensive instrumentation and is a safe, effective procedure for improving nasal breathing in patients with chronic obstructive inferior turbinates, both on a short-term and long-term basis.     

The clinical value of the novel cauterization procedure for the inferior turbinate artery during turbinate surgery

The objective of the study was to evaluate the efficacy and the safety of the novel cauterization procedure of the inferior turbinate artery, which may be performed with any kind of inferior turbinate procedures in reducing the intra and the post-operative bleeding in partial inferior turbinectomy. A prospective controlled study was conducted in a referral center. Sixty patients (38M, 22F) who underwent partial turbinectomy were included. In 20 patients, partial turbinectomy was performed with the cauterization in one nasal cavity and the other one without it. The remaining 40 patients were divided into two groups which comprised cauterization positive and negative patients and are assessed in terms of post-operative bleeding. The area of the cauterization was 1 cm² field which is 1 cm anterior to the posterior attachment of the inferior turbinate on the lateral nasal wall, very close to the inferior turbinate, where the pulsating vessel is most commonly seen. Mean operation time, mean intra-operative blood loss and post-operative bleeding incidence are the main outcome measures. Post-operative bleeding was seen in three patients (15%) in the cauterization negative group. No patient had post-operative bleeding in the cauterization positive group. Mean operation time and mean intra-operative bleeding amount were significantly lower in the cauterization positive side. Cauterization of the inferior turbinate artery on the lateral nasal wall is a safe and effective method which may also be performed with any kind of inferior turbinate procedures to reduce both the operation time and intra and post-operative bleeding.     

Revision septoplasty: review of sources of persistent nasal obstruction

BACKGROUND: Patients with nasal obstruction from septal deviation commonly undergo septoplasty to improve nasal airflow. Some patients suffer from persistent obstruction after their primary septoplasty and may undergo a revision septoplasty to improve their nasal passageway. Our objective was to identify patients who underwent revision septoplasty and to identify their sources of persistent nasal obstruction. METHODS: Patients who underwent septoplasty at our institution between 1995 and 2005 were reviewed. Data is collected on demographics, comorbidities, age at septoplasty, associated and concomitant procedures, surgical approach, and anatomic site of obstruction. RESULTS: Five hundred forty-seven patients met inclusion criteria including 477 who underwent primary septoplasty and 70 who underwent revision surgery. Nineteen percent of nonrevision patients underwent nasal valve surgery along with their primary septoplasty versus 4% of patients in the revision group. Fifty-one percent of revision patients had nasal valve surgery at revision surgery. Patients who underwent sinus surgery along with primary septoplasty were less likely to undergo revision septoplasty. History of facial trauma, obstructive sleep apnea, site of deviation, and performance of inferior turbinate surgery did not affect the likelihood of revision septoplasty. CONCLUSION: A significant number of patients who undergo revision septoplasty also have nasal valve collapse. We recommend that in addition to septal deviation and inferior turbinate hypertrophy, nasal valve function be fully evaluated before performing septoplasty. This will help to ensure a complete understanding of a patient's nasal airway obstruction and, consequently, appropriate and effective surgical intervention.     

Anterior turbinectomy. A new surgical approach to turbinate hypertrophy: a review of 220 cases

Surgical correction of mechanical nasal airway obstruction is commonly treated by septoplasty. The nasal airflow, however, is often inadequate postoperatively. The inferior turbinates are responsible for nasal obstruction more often than is realized. Recent studies have confirmed that the main site of respiratory resistance is located at the level of the anterior ends of the inferior turbinates. A new turbinectomy approach in which the anterior end of the inferior turbinate is resected with a specially modified forceps is described. A large series of patients, along with their follow-up data, are described. The advantages of the anterior turbinectomy are discussed.     

下鼻甲肥大对功能性溢泪影响的分析

目的探讨下鼻甲肥大与功能性溢泪的关系及临床治疗价值。方法 11例下鼻甲肥大伴溢泪患者中,7例同时伴鼻中隔偏曲,术前完善检查,并利用CT泪囊造影术和三维重建,排除溢泪的眼部疾病,行下鼻甲减容术伴或不伴鼻中隔偏曲矫正术,观察疗效。术后随访12个月。结果 11例患者中8例(72.7%)溢泪症状消失,3例(27.3%)溢泪症状好转。7例患者术后鼻中隔均居中,下鼻甲明显缩小。其中鼻塞痊愈10例(90.9%),好转1例(9.1%)。结论下鼻甲肥大为功能性溢泪的一个重要的原因,对其进行治疗可治愈或改善功能性溢泪。