Anterior Turbinectomy: A New Surgical Approach to Turbinate Hypertrophy: A Review of 220 Cases

Abstract

\s=b\ 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. (Arch Otolaryngol Head Neck Surg 1986;112:850-852) Surgeons performing large numbers of septoplasties soon discover the limitations and unpredictability of this procedure and eventually come to realize that additional factors are at least as important as a deviated sep¬ tum in producing nasal obstruction. In this report, I will discuss the most important of these factors: hypertro¬ phy of the turbinâtes. A new approach to surgery of the turbinâtes is pre¬ sented and its results evaluated. SURGERY OF THE TURBINATES Past TechniquesThe significance of the turbinâtes in nasal breathing was acknowledged years ago. Generous excision of the turbinâtes was practiced but soon abandoned due to the many complica¬ tions arising from this procedure, namely secondary atrophie rhinitis and profuse postoperative bleeding.Other, more conservative, turbinate managements included partial exci¬ sion, electrocautery, cryosurgery, sub¬ mucous resection, crushing, and outfractioning.13 The partial inferior tur¬ binectomy performed along the free border of the turbinate elicited the best results among these procedures but still entailed significant disadvan¬ tages, including a high rate of postop¬ erative bleeding (up to 10% according to Goode1) and technical difficulty.Less destructive alternatives, such as electrocautery and cryosurgery, pro¬ duced less satisfactory results and yielded only temporary improvement in many instances.The aforementioned techniques all manifest a common factor in that they work on the entire length of the turbinâtes. A consideration often overlooked is that the crux of the problem lies in the anterior tip of the inferior turbinate, rather than along its length. It is that part of the inferi¬ or turbinate located at the nasal valve area that controls, and sometimes dis¬ rupts, all nasal traffic. The Nasal Valve and the Inferior TurbinateThe nasal valve consists of a circu¬ lar constriction formed inferiorly by the piriform crest, superiorly by the limen nasi, and medially by the corre¬ sponding strip of nasal septum. Any of these three components, when dis¬ placed internally, will further narrow the valve diameter and lead to respi¬ ratory obstruction. The same princi¬ ple also applies to structures located close to the valve fold, whether these structures lie immediately anterior to the valve (eg, alar cartilage) or imme¬ diately poster...

Comparison between Power-Assisted Turbinoplasty and Submucosal Resection in the Treatment of Inferior Turbinate Hypertrophy

“…Several different methods have been proposed for the treatment of inferior turbinate hypertrophy, including partial and total turbinectomy, submucosal turbinectomy, submucosal diathermy, cryotherapy and laser turbinoplasty [3][4][5][6][7] . However, the main disadvantages of these techniques are the loss of mucosa and interference with mucociliary function [8] .…”

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

“…Various surgical methods have been proposed for the treatment of hypertrophic inferior turbinates, including cryotherapy, submucosal diathermy, laser turbinoplasty, submucosal turbinectomy, and partial and total turbinectomy [4,[6][7][8][9][10]. The variety of surgical techniques available reflects the general lack of consensus regarding the most suitable technique for the management of hypertrophic inferior turbinates.…”

Therapeutic approach in monosymptomatic nasal obstruction

“…Over time, various techniques of reduction of the inferior turbinates mucosa volume have been described: diathermocoagulation, partial or total turbinectomy, cryotherapy, laser volumetric reduction (diode, CO2, KTP-Yag) or radiofrequency [39][40][41][42][43][44][45] .…”