Understanding submucosal electrosurgery for the treatment of nasal turbinate enlargement

Abstract

The surgical management of inferior turbinate enlargement is controversial. Submucosal electrosurgical techniques for turbinate reduction include conventional diathermy, radiofrequency tissue reduction and coblation. All electrosurgical techniques use radiofrequency electricity to damage turbinate tissue but differ in the control and delivery of energy. This review will examine the history of submucosal electrosurgery and clarify the various techniques. This review will also examine the evidence for the efficacy and safety of electrosurgery for the treatment of nasal turbinate enlargement, and will make a case that no progress will be made in clinical trials on the safety and efficacy unless there is standardisation of equipment and techniques in nasal electrosurgery.

Comparison of Partial Inferior Turbinectomy and Submucosal Diathermy for Hypertrophied Inferior Turbinate in Allergic Rhinitis Patients

“…Diathermy produces very high local temperatures due to ohmic heating, resulting in tissue destruction by boiling & coagulation. 6 In patients with hypertropied inferior turbinate the superficial layer of lamina propria is significantly increased in size and there is increase in the submucosal glands & venous sinusoids. 21 SMD causes obliteration of these venous sinusoids leading to submucosal fibrosis & scarring of lamina which is thought to anchor the mucosa to the periosteum.…”

“…Therefore a small change in the inferior turbinate will dramatically affect nasal airflow, which is the physiological basis on which reduction of inferior turbinate tissue rests. 5 The first surgical procedure for the treatment of enlarged inferior turbinate was reported by Heider & Crusel in 1845 when they described surface electrocautery using a galvanic current 6 . Latter Hol & Hiuzing evaluated 13 surgical techniques that have been used for inferior turbinectomy in last 130 years.…”

“…Latter Hol & Hiuzing evaluated 13 surgical techniques that have been used for inferior turbinectomy in last 130 years. 6 Surgical techniques for managing ITH vary widely & have evolved substantially in past 4 decades as new technologies have emerged. 7 Today many surgical options exists for the treatment of hypertrophied inferior turbinate directed primarily at the underlying nasal obstructive component.…”

“…8 These procedures addresses the bone, submucosa, mucosa or combination of these. Procedures like linear cautery, submucosal diathermy, 6 cryosurgery, 9 lateral outfracturing, 10 antrochonopexy, 11 submucosal resection, radiofrequency ablation, 12 partial turbinectomy, 9 total inferior turbinectomy, 13 laser turbinectomy, 14 20 But with rural patients being more predominant, cost being a major issues we wanted to try simpler methods which did not require sophisticated, costly instruments & one which could be easily done at lesser cost. Hence this study was conducted to evaluate & analyze the impact of either of the two above mentioned procedures on nasal obstruction.…”

Surgery of the turbinates and “empty nose” syndrome

“…It proposes that future advances in the area of clinical studies can only be made by defined standards [101]. …”