Controversies in the Management of Inferior Turbinate Hypertrophy: A Comprehensive Review

Abstract

Nasal obstruction must frequently be addressed during functional rhinoplasty. Even after a properly performed septorhinoplasty correcting septal deflection and/or nasal valve collapse, nasal obstruction may persist due to turbinate hypertrophy. Turbinates have many important functions, including warming and humidification of inspired air, and numerous factors can contribute to pathologic enlargement. Management of inferior turbinate hypertrophy has been actively debated for more than a century. The primary goal of therapy is to maximize the nasal airway for as extended a period as possible while minimizing complications of therapy, such as nasal drying and hemorrhage. This review describes the various medical and surgical therapeutic modalities widely used today, with emphasis placed on surgical management of the inferior turbinates. Advantages, disadvantages, complications, and controversies of each form of treatment are reviewed and discussed. A staged protocol of increasingly invasive interventions is proposed.

Surgery of Turbinate Hypertrophy What can This Give Us?

“…pro ach may of fer a fe a sib le im pro ve ment in na sal func ti on and, the re fo re, in the symptoms re ported by pa ti ents, thus be co ming ne ces sary when ae ti o logy of na sal obs truc ti on is of an or ga nic natu re. 1,3,5,6 Va ri o us sur gi cal tech ni qu es are cur rently used to res to re na sal func ti on by mec ha ni cal reduc ti on of the lo wer tur bi na te and, pos sibly, preser ve the mu co sa. The sur gi cal tech ni qu es most fre qu ently emp lo yed in hyper trophy of the tur bina tes 4,7 are: Tur bi nec tomy: this pro ce du re is perfor med by in du cing a me di ally and up per di rec ted frac tu re of the lo wer tur bi na te.…”

“…[1][2][3][4] When medical therapy is ineffective, a surgical ap- A AB BS S T TR RA AC CT T The sur gi cal ma na ge ment of lo wer tur bi na te hyper trophy in rhi nop lasty gi ves ri se to much dis cus si on. Aim of the pre sent in ves ti ga ti on was to es tab lish, by me ans of the analy sis of a large pa ti ent po pu la ti on, the ef fi cacy and rep ro du ci bi lity of high fre qu ency sur gery, in the tre at ment of' this con di ti on.…”

The Value of Intranasal Splints After Partial Inferior Turbinectomy

“…A variety of surgical procedures are performed for treatment of hypertrophic inferior turbinates such as total, partial or submucous turbinectomies, turbinoplasties, besides other procedures, such as electrocautery, chemocautery, cryosurgery, laser surface surgery. A recent addition is endoscopic shaver turbinectomy and coblation [2]. However the surgery widely practiced in our setup is ''bilateral partial inferior turbinectomy''.…”

Outcome Assessment of 603 Cases of Concomitant Inferior Turbinectomy and Le Fort I Osteotomy

“…Th e allergic turbinate hypertrophy can be managed with medications, such as corticosteroids, and if this approach fails, surgery may be necessary (13). When a deviated septum is identifi ed, the turbinate associated with the aff ected side is usually enlarged.…”

“…Multiple surgical modalities have been advocated to address the hypertrophied turbinate, including turbinate outfracture, electrocautery, reduction by a microdebrider, cryosurgery, coablation, laser reduction, partial or total turbinate resection, use of radiofrequency, submucous turbinate resection, and vidian neurectomy (13,(15)(16)(17)(18)(19). Th e aim of this retrospective study was to perform an outcome assessment of partial inferior turbinectomies (PIT) performed simultaneously with Lefort I osteotomies and analyze the related data for complications, gender…”