Tuesday, January 31, 2012

When is a turbinectomy indicated?

When is a turbinectomy indicated?

Nasal obstruction is the most common complaint treated by otolaryngologists.

Turbinectomy or conchotomy is the surgical removal of an abnormally enlarged turbinate, which opens up the nasal passages by removing bone and soft tissue from inside the nose to improve breathing.

The turbinate or conchae is a bone in the nose; it is an extension of the ethmoid bone and is situated along the sidewall of the nose, covered by mucous membrane.

 It may be warranted in cases in which the upper airway is obstructed due to:
  • deviated nasal septum
  • swelling of the turbinate due to allergy, chronic inflammation, or chronic sinusitis
  • nasal polyps or other tumour obstructing the nose
  • swelling of the adenoids

When a 'turbinate bone' or 'conchae' is abnormally enlarged, it produces an ‘empty nose syndrome’, with symptoms like chronic nasal dryness, inflammation, 'paradoxical obstruction' (loss of airflow sensation) leading to breathing difficulties, grogginess and dizziness, and often pain and repeated nasal infections. These symptoms have a significant impact on the patient’s quality of life and sense of well-being. It can produce difficulty concentrating (appears in the medical literature as 'aprosexia nasalis'), pre-occupation with symptoms, anxieties and often clinical depression.[1]
The goals of nasal airway surgery include the following: to improve airflow through the nose, to control nosebleeds, to enhance visualization of the inside of the nose, to relieve nasal headaches associated with swelling of the inside of the nose, and to promote drainage of the sinus cavities. Nasal airway surgery is done through the nostrils without the need for external incisions.
Over resection of the inferior turbinates in the nose may lead to chronic nasal dryness, chronic mucosal inflammation, squamous metaplasia, mucosal atrophy and in rare cases even to full blown atrophic rhinitis. The remaining mucosal structures (the septum and the remaining turbinates) often hypertrophy and complicate diagnosis.[2][3][4][5][6]
  • Rice DH, Kern EB, Marple BF, Mabry RL, Friedman WH. The turbinates in nasal and sinus surgery: a consensus statement. Ear Nose Throat J. 2003;82(2):82-84.
  • Cottle MH. Nasal Atrophy, Atrophic Rhinitis, Ozena: Medical and Surgical Treatment. Journal Of The International College Of Surgeons. Volume 29(4), pages 472-484, 1958.
  • Pass├áli D, Lauriello M, Anselmi M, et al. Treatment of the inferior turbinate: long-term results of 382 patients randomly assigned to therapy. Ann Otol Rhinol Laryngol. 1999;108:569-75.
  • Moore GF, Freeman TJ, Yonkers AJ, Ogren FP. Extended follow-up of total inferior turbinate resection for relief of chronic nasal obstruction. Laryngoscope,  1985 Sept., volume 95 (9 Pt. 1): 1095-9.
  • Berenholz L, et al'. Chronic Sinusitis: A sequela of Inferior Turbinectomy. American Journal of Rhinology, July-August 1998, volume 12, number 4.
  • Wang Y, Liu T, Qu Y, Dong Z, Yang Z. Empty nose syndrome. Zhonghua Er Bi Yan Hou Ke Za Zhi. 2001 Jun;36(3):203-5.

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