Outfracture of the Inferior Turbinate: A Computed Tomography Study

Abstract

BACKGROUND: Various surgical treatment modalities are available for inferior turbinate (IT) hypertrophy. Each is related with well-established complications, but still there is a lack of consensus on the optimal technique. Outfracture of the IT is thought to be a minimal destructive procedure among all other reductive turbinate interventions. Our aim was to assess the long term effects of IT outfracture technique in patients with mild or moderate IT hypertrophies. METHODS: Twenty ITs in 10 patients were outfractured during a septoplasty procedure. The distance of the IT bone to the lateral nasal wall was compared at 3 different levels of the nasal passage before and after (at 9 months) surgery with computed tomography scans of each patient at (1) the first section in which the IT bone could be seen entirely (anterior portion), (2) the level of the maxillary sinus ostium (middle portion), (3) the last section in which the IT bone could be seen entirely (posterior portion). RESULTS: A statistically significant degree of lateralization was observed at all levels in all patients. The mean lateralization rates were 15%, 26%, and 23% for the right side, and 26%, 29%, and 25% for the left side at first, second, and third levels, respectively. There was no bleeding, edema, or crusting due to the outfracture procedure in any patient. CONCLUSIONS: Our results suggest that outfracture of the IT is an effective and durable technique, which can be performed easily to enlarge the nasal airway in mild and moderate IT hypertrophies with minimal morbidity.

Inferior Turbinoplasty During Cosmetic Rhinoplasty

“…1,28 Because of reports of these complications, a less radical approach to the problem evolved, and partial turbinate reduction procedures were adopted. 8,11 In 1924, the submucous resection was described; it was further popularized in the 1950s. 1,12,29 During the subsequent several decades, submucous reduction and surgical turbinate reduction were widely practiced.…”

“…1,12,29 During the subsequent several decades, submucous reduction and surgical turbinate reduction were widely practiced. 8 Beginning in the 1990s, however, there was a greater emphasis on research and development of new technologies for turbinate reduction, such as cryosurgery, 26 electrocautery, 11 radiofrequency ablation, 15Y19 laser cautery, 20Y25 and microdebridement of the turbinate mucosal tissues. 30 This study demonstrates that most of the ASPS members polled include an evaluation of inferior turbinate hypertrophy as part of a comprehensive rhinoplasty consultation.…”

“…A multitude of destructive and nondestructive surgical techniques have been used to reduce enlarged turbinates. 8 The sheer number of accepted approaches belies the lack of agreement on which approach is the optimal one.…”

Morphological consequences of lateral outfracture of the inferior turbinate

“…The unpredictability of the effects of inferior turbinate outfracture has also been noted by Buyuklu et al 3 They measured the distance from the lateral border of the inferior turbinate bone to the lateral wall of the nose, in Turkish patients with mild to moderate enlargement of the inferior turbinates who were undergoing septoplasty and inferior turbinate outfracture. The same outfracture technique was used.…”

Advances in the Surgical Management of Chronic Sinusitis and Nasal Polyps

“…Mucosal-sparing techniques are currently in favor due to lack of associated crusting, synechiae, bleeding, and discomfort. Inferior turbinate outfracture is the simplest method, and CT examination postoperatively showed that lateralization had been maintained at 9-month follow-up [20]. Submucous resection by traditional techniques or in the microdebrider-assisted technique appears to create the greatest volumetric reduction with the longest-lasting result [21].…”