Experiences in middle turbinectomy

Abstract

Rhinologists have long cautioned about removal of the middle turbinate, though exenteration of the ethmoid labyrinth including the middle turbinate has shown the structure can be sacrificed. The middle turbinate can be removed in the crowded nose often with septoplasty and partial inferior turbinectomy, to improve the nasal airway. A vasoactive middle turbinate which engorges and compresses against an often deviated nasal septum gives rise to the “four finger headache” patient for whom middle turbinectomy, often with septoplasty, is helpful. Point cocainization of the compressed site helps prognosticate the good candidate for surgical relief. Patients with purulent sinusitis have been excluded from the study. Results have been good to excellent with no long‐term adverse sequelae. There has been no crusting, drying, or infection as a result of our middle turbinectomies. Careful patient selection is critical.

Dor craniofacial e anormalidades anatômicas das cavidades nasais

“…The causal relation between nasal anatomical variations and headache became the object of investigation of many different authors that started to give special attention to the role of sensorial inervation of the nasal cavity, because its stimulation, specially mechanical, would be considered the triggering of the referred pain 6,4,[8][9][10] .…”

“…The importance of the sensorial inervation of the nasal mucosa in triggering the painful symptom was reinforced by the relief of pain after application of topical anesthesia, cocaine, in the nasal cavity, specifically between the medium concha and the septum, whose sensitivity is conducted by the anterior ethmoid nerve 3,8,10,13 . Vasoconstrictors 9 and lidocaine 13 , that cause immediate relief, characterize the positive response to the test, whose clinical meaning will be shown later.…”

“…It was considered that the stimulus of the reported nasal mucosa region was caused by the contact between the subsequent nasal structures of anatomical variations of constitutional or traumatic origin 4,8,15 , medium concha hypertrophy or pneumatization 3,11,14,16 .…”

“…As to type and intensity of pain there are descriptions of intermittent pain 3,8 , with pressure characteristics 15,22 , pulsatile or sharp 9 , severe and disabling 9,22 , and many authors consider it mild to moderate 3 . As to location, inner canthus, supraorbital and frontal region 3,8,9,15,22 and it may reach the orbit 9 , infraorbital region and temporal-zygomatic region 8,22 , both unilateral 3 and bilateral, when it forms the fourfinger syndrome, in an allusion to the position taken by the victims of these symptoms 8,22 .…”

“…It is noted, though, that many factors may be implied in the production of pain of nasal etiology, so as that the pathophysiological aspect that relates nasal anatomical variations and craniofacial pain becomes more important. Many authors have studied the topic since the beginning of the century, defining clinical syndromes such as anterior ethmoid nerve syndrome 6 , nasociliary nerve syndrome, olfactory tissue syndrome 7 , septal contact headache 4 , four-finger headache syndrome 8 and nasal spore headache 9 . Many clinical observations made by these authors, including the good results of treatment of these patients with simple clinical procedures, are relevant in the determination of the cause-relation between nasal anatomical variations and craniofacial pain.…”