Procedures: Turbinate Reduction

This page describes some aspects of surgically reducing the size of nasal turbinates..

 

What are the turbinates?

Nasal turbinates, also known as nasal conchae, are elongated bony structures located within the nasal cavity. They are covered with a layer of mucous membrane. There are three main pairs of turbinates on each side of the nasal cavity: the inferior, middle, and superior turbinates.

Their primary function is to filter, warm, and humidify the air that passes through the nasal passages before it reaches the lungs. As air flows through the nasal cavity, the turbinates create turbulence, which helps to trap dust, allergens, and other particles in the mucus, ensuring that cleaner air enters the respiratory system.

The turbinates also play a role in sensing and regulating airflow and are involved in the sense of smell. When the turbinates are enlarged, there is less space for airflow. They can increase in size and shape and may swell or shrink in response to factors such as allergies, infections, or irritants, which can affect breathing and overall nasal function. Additionally, the inferior turbinates can enlarge due to the engorgement of blood vessels in the nasal mucosa.

In some cases, enlarged turbinates may require medical attention or surgical intervention to improve airflow.

why do the inferior turbinates affect nasal airflow so much?

The inferior turbinates affect nasal airflow more than the other turbinates mostly because the front of the inferior turbinates help form the narrowest part of the airway at the internal nasal valve.

what are middle turbinate concha bullosa?

Middle turbinate concha bullosa refers to a condition in which the middle turbinate, a curved structure in the nasal cavity, is air-filled and enlarged. The presence of a concha bullosa can lead to nasal obstruction and may contribute to chronic sinusitis, as it can affect the drainage of the sinuses.

Diagnosis is typically made through imaging studies, such as a CT scan of the sinuses, which can provide detailed views of the nasal anatomy. Treatment options vary based on symptoms and may include medical management, such as nasal corticosteroids, or surgical intervention to reduce the size of the concha bullosa.

How are the inferior turbinates surgically reduced in size?

The inferior turbinates can be reduced in size through several surgical techniques aimed at alleviating nasal obstruction and improving airflow. Common methods include:

  1. Submucosal Resection: This technique involves the removal of a portion of the turbinate bone beneath the mucosal lining. Some of the inferior mucosal lining may be removed at the same time. The tissue removed is typically anterior (toward the nostrils), where the nasal airway is narrowest, allowing preservation of the normal function of the remainder of the inferior turbinate.

  2. Inferior Turbinate Lateralization: In this approach, the turbinate is repositioned laterally (to the side) to widen the airway. This technique may be combined with other techniques that reduce the size of the turbinates.

  3. Radiofrequency Ablation: A minimally invasive procedure, which may be performed in the operating room or clinic, uses radiofrequency energy to heats and shrink the turbinate tissue, resulting in a reduction in size.

  4. Others: multiple other techniques have been proposed to reduce the size of the inferior turbinates, essentially using the same concept of destroying or removing tissue.

Each method has its own indications, advantages, and potential risks. The choice of technique is made based on the individual situation.

what are the risks of surgical reduction of the turbinates?

Surgical reduction of the turbinates carries several potential risks, including the following:

  1. Bleeding: Intraoperative or postoperative bleeding is a common risk. Although usually manageable, significant bleeding may necessitate further intervention.

  2. Infection: Any surgical procedure introduces the risk of infection. Postoperative infections can lead to complications that may require additional treatment (such as with antibiotics) or, less likely, additional surgery.

  3. Nasal obstruction: Ironically, while the goal of the surgery is to improve airflow, some patients may experience a sense of persistent or worsening nasal obstruction, which may be if the turbinates are over-reduced.

  4. Altered sense of smell: There is a risk, albeit low, of altered olfactory function due to changes in the nasal structure.

  5. Adhesion formation: Scar tissue may develop post-surgery, potentially causing synechiae (adhesions between the turbinates and surrounding tissues), which can affect nasal airflow.

  6. Need for revision surgery: In some cases, patients may require additional surgical interventions to achieve the desired results or to address complications from the original procedure.

  7. Change in voice quality: Rarely, some individuals may experience changes in their voice due to alterations in nasal resonance post-surgery.

  8. Injury to nearby strucures: As with all surgery there is potential for inadvertent injury to nearby structures.

 

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