How I Do It: Inferior Turbinectomy: Modified Techniques for Submucosal Resection

Omura, Kazuhiro; Nomura, Kazuhiro; Takeda, Teppei; Yanagi, Norihiro; Kuroyanagi, Hiroki; Yanagihara, Taichi; Tanaka, Yasuhiro; Kojima, Hiromi; Otori, Nobuyoshi

doi:10.1177/21526567211034736

Cited by 5 publications

(13 citation statements)

References 11 publications

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“…Inferior turbinate surgery for the hypertrophied inferior turbinate is 1 of the most common procedures performed by otolaryngologists. 1 Multiple conditions such as vasomotor rhinitis, allergic rhinitis, and excess use of vasoconstrictor drops may be the cause of inferior turbinate hypertrophy. 2 Additionally, inferior turbinate hypertrophy is usually observed with septal deviations (compensatory hypertrophy) and is associated with chronic rhinosinusitis.…”

Section: Introductionmentioning

confidence: 99%

“…These options include total turbinectomy, partial turbinectomy, submucosal resection, laser surgery, cryosurgery, electrocautery, radiofrequency ablation, and turbinate out-fracture. 1 However, there remains a lack of consensus for the preferred technique. 5 The aim of turbinate surgery is to decrease the inferior turbinate size so that the symptoms get reduced while conserving the anatomy and function of the nasal airways and reducing complications rates.…”

Section: Introductionmentioning

confidence: 99%

“…7 Inadequate reduction may result in less satisfactory improvement in the patient symptoms of nasal obstruction. 1 Crust formation occurs more frequently when the turbinate mucosa is damaged. Bleeding also occurs when the mucosa is damaged or lost, or when the small arterioles penetrating the periosteum are injured.…”

Section: Introductionmentioning

confidence: 99%

“…Bleeding also occurs when the mucosa is damaged or lost, or when the small arterioles penetrating the periosteum are injured. 1 Foul odor, pain, synechiae, bone necrosis, and infection occur similarly due to damage of the mucosa with subsequent mucociliary impairment. 3,8 Coblation is a technique that utilizes bipolar radiofrequency energy for soft tissue dissolution.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Medial Flap Coblation Turbinoplasty Versus Submucous Resection: Outcomes

Etman

Ebada

El-Sisi

2023

Am J Rhinol�Allergy

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Background Variable surgical options are available for turbinate reduction. These options include total turbinectomy, partial turbinectomy, submucosal resection, laser surgery, cryosurgery, electrocautery, radiofrequency ablation, and turbinate out-fracture. However, there remains a lack of consensus for the preferred technique. Objectives The aim of this study was to describe the use of coblation for medial flap turbinoplasty procedure. Furthermore, the outcomes of this technique were compared to submucous resection in terms of improvement of patients’ symptoms, postoperative bleeding, crusting, and pain scores. Methods This prospective, randomized, comparative surgical trial was conducted on 90 patients. Patients were randomly allocated into 2 groups: medial flap coblation turbinoplasty group ( n = 45), and submucous resection group ( n = 45). The outcomes of both techniques were analyzed and compared. Results Both techniques were equally in alleviating patients’ symptoms of nasal obstruction. However, postoperative healing was significantly better in medial flap coblation turbinoplasty group. Additionally medial flap turbinoplasty showed a statistically significant better outcome in terms of postoperative bleeding, crusting and pain scores. Conclusion Both submucous resection and medial flap coblation turbinoplasty are effective in relieving nasal obstruction and enabling optimal volume reduction with preservation of function of the inferior turbinate. Coblation turbinoplasty has superior outcomes in terms of better healing and less postoperative pain and crusting.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Medial Flap Coblation Turbinoplasty Versus Submucous Resection: Outcomes

Etman

Ebada

El-Sisi

2023

Am J Rhinol�Allergy

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In Response to Cost‐effectiveness Analysis of Inferior Turbinate Reduction and Immunotherapy in Allergic Rhinitis

Yong,

Aravinthan,

Kirubalingam

et al. 2023

The Laryngoscope

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We are pleased that the EUFOREA Expert Panel has shared their opinion, as a multispecialty approach to allergic rhinitis (AR) is necessary to expand the options available to patients. 1 Although inferior turbinate reduction (ITR) has traditionally been viewed as a procedure strictly targeting nasal obstruction, there is an evolving understanding that modern techniques can provide additional benefits with a low rate of complications. ITR for the treatment of AR has now been shown to significantly improve sneezing and rhinorrhea which is sustained beyond 1 year after surgery. 2 Additionally, the role of the inferior turbinate in nonallergic rhinitis is being increasingly recognized. Submucous resection may have a beneficial effect through the disruption of overactive parasympathetic neurovascular supply in the inferior turbinate. 3 Furthermore, ITR techniques have evolved over time and no longer involve radical mucosal resection, but rather mucosalsparing techniques such as controlled ablation or removal of the submucous tissues. These approaches preserve the function but dampen the reactivity of the turbinate. 4,5 Allergen immunotherapy (AIT) remains an important treatment for patients as it can modify the underlying immune response. However, consideration of ITR as an upfront or concurrent treatment would only serve to expand available options for patients, as ITR would not preclude allergy testing and AIT. ITR may offer a more immediate effect when compared to the time it typically takes to perform allergen testing and reach AIT maintenance dosing. 6 Furthermore, ITR may be beneficial to patients who are not candidates for AIT. In addition, although there has been some exploration of the link between untreated AR and the development of asthma, there has not been a causative link identified. 7,8 It could be postulated that because the inferior turbinate itself plays a major role as the first anatomic structure which samples inspired air, dampening of its reactivity by way of ITR may alter the progression of AR and, by extension, asthma. However, this discussion remains speculative.Lastly, we believe that the results of the analysis reflect a real-world approach to clinical decision-making. Testing such as acoustic rhinometry is rarely if at all performed in the clinical setting and does not affect the decision to proceed with ITR. 9 Additionally, although societal factors such as losses of productivity were not captured in the analysis, these factors would be applicable to both ITR and AIT, as the societal costs of referral delays, AIT rampup period, and nonresponse would be nontrivial.

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Epidemiology of postoperative bleeding after endoscopic nasal and sinus surgery and factors associated with bleeding

Hemmi,

Nomura,

Kobayashi

et al. 2023

Eur Arch Otorhinolaryngol

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Purpose Endoscopic nasal and sinus surgery is a surgical procedure frequently performed by otolaryngologists. Postoperative bleeding is detrimental to both healthcare providers and patients. We investigated the epidemiology of postoperative bleeding during endoscopic nasal and sinus surgery and explored possible bleeding triggers. Methods We evaluated the patients who underwent endoscopic nasal and sinus surgery. Data regarding the age, sex, presence of hypertension, and abnormal coagulability, including oral anticoagulants, diagnoses, operative procedures, intraoperative use of drills and blood loss, and postoperative antimicrobial administration of eligible patients, were extracted from medical records and retrospectively reviewed. Results One hundred and eighty-six patients underwent endoscopic nasal or sinus surgery during the study period, and postoperative bleeding occurred in 9 patients (4.8%). Posterior nasal neurotomy (PNN) was the procedure most likely to cause postoperative bleeding (4 surgeries, 13.3%). Postoperative antimicrobial administration significantly reduced the incidence of postoperative bleeding (p = 0.04). Conclusions Postoperative bleeding requiring intervention occurs in 4.8% of cases, and PNN is associated with a high risk of postoperative bleeding. Wound infection is a potential cause of postoperative bleeding, and antimicrobial administration should be considered in addition to local treatment.

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How I Do It: Inferior Turbinectomy: Modified Techniques for Submucosal Resection

Cited by 5 publications

References 11 publications

Medial Flap Coblation Turbinoplasty Versus Submucous Resection: Outcomes

Medial Flap Coblation Turbinoplasty Versus Submucous Resection: Outcomes

In Response to Cost‐effectiveness Analysis of Inferior Turbinate Reduction and Immunotherapy in Allergic Rhinitis

Epidemiology of postoperative bleeding after endoscopic nasal and sinus surgery and factors associated with bleeding

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