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Nasal Turbinate Surgery

Οι ρινικές κόγχες είναι προσεκβολές του πλάγιου ρινικού τοιχώματος, που υπερτρέφονται συχνά στα πλαίσια χρόνιας ρινίτιδας. Η κάτω ρινική κόγχη εμποδίζει περισσότερο από τις άλλες και, σε περίπτωση υπερτροφίας, απαιτεί διόρθωση.
Nasal turbinates are protrusions of the lateral nasal wall, which often enlarge to an abnormal size, due to chronic inflammation. Inferior turbinate is the most important of the three for the airflow, and needs reduction in case of hypertrophy.
The nasal turbinates are protrusions of the lateral wall of the nose. They have a bony skeleton and are covered with mucosa, which is the same with the rest of the interior of the nose. Chronic inflammation of the nasal mucosa (Chronic Rhinitis) often causes enlargement of the turbinates and disturbs the nasal airflow.
 
When there is significant enlargement of the turbinates, surgical reduction is needed. This can be done with various methods, including the Laser, radiofrequencies, microdebrider, and finally by means of submucosal turbinectomy. The most appropriate method of treatment for each case will be decided taking into consideration the patient’s history, the clinical examination, and of course, the surgeon’s experience.

It must be underlined that, apart from any method of surgical reduction, it is absolutely essential that the underlying pathological condition, which is Chronic Rhinitis, should be appropriately investigated and treated. This combined treatment (medical and surgical) is the only way to a satisfactory, long lasting favourable result.

Laser Turbinoplasty

Various Lasers have been used for many years for the reduction of nasal turbinates. The Laser beam causes controlled thermal effect to the tissues, and the scarring, which follows, shrink the hypertrophied turbinate. Although our Team has extensive experience with the use of Lasers, we do not use them anymore. We feel that, especially in the case of superficial application (CO2 Laser), the thermal damage to the functional mucosa is not in accordance with the modern idea of minimally invasive surgery.

Carbon dioxide Laser has been used for several years for the reduction of the nasal turbinates. In this picture, a typical Laser apparatus is shown. The nurse holds the handpiece which is usually used for turbinate surgery.
Carbon dioxide Laser has been used for several years for the reduction of the nasal turbinates. In this picture, a typical Laser apparatus is shown. The nurse holds the handpiece which is usually used for turbinate surgery.

Radiofrequency Turbinoplasty

Radiofrequencies work with radiowaves, similar to those of microwave ovens. A special electrode is inserted in the turbinate and it produces a thermal effect, similar to that produced by the Laser. Most important advantages of radiofrequency turbinectomy are low cost, safety, and ease of application, even at an outpatient setting under local anaesthesia. The procedure can be repeated, if needed.

Radiofrequency Turbinectomy: The bipolar electrode has been inserted inside the turbinate, and the thermal effect on the tissues is shown as whitening under the mucosa (arrows).
Radiofrequency Turbinectomy: The bipolar electrode has been inserted inside the turbinate, and the thermal effect on the tissues is shown as whitening under the mucosa (arrows).

Microdebrider Turbinoplasty

The reduction of the volume of the turbinate is done with a specialized micro-cutting apparatus, called microdebrider or shaver. Through a small 2 mm incision, a minute rotating knife, connected to the suction, is inserted inside the turbinate and removes excess tissue. This method respects the superficial mucosa, which is the functional organ of the nasal air conditioner. The operation is done under general anaesthesia, and is typically combined with other nasal procedures, such as the correction of the septal deviation. Nasal packs are not used.
 
In our hands, this method has the best results and the smallest complication rate.
Microdebrider turbinectomy: The special 2 mm blade is inserted inside the volume of the turbinate through a 2 mm incision and debulks the enlarged turbinate without disturbing the functionally important superficial mucosa.
Microdebrider turbinectomy: The special 2 mm blade is inserted inside the volume of the turbinate through a 2 mm incision and debulks the enlarged turbinate without disturbing the functionally important superficial mucosa.
Microdebrider Turbinectomy: A week after the operation, the only thing seen on the turbinate is the trace of the minute incision (arrow). The turbinate has already stabilized to the desired size.
Microdebrider Turbinectomy: A week after the operation, the only thing seen on the turbinate is the trace of the minute incision (arrow). The turbinate has already stabilized to the desired size.

Submucosal Turbinoplasty

When the turbinate bone is large, soft tissue removal or debulking, as in previously discussed methods, is not enough for a satisfactory result. In these cases, submucosal bone removal is combined with excision of excess soft tissue with this endoscopic operation, which is done under general anaesthesia. The result is immediately obvious. No packs are used.

When soft tissue debulking is not enough and turbinate bone must also be removed, this can be done by means of the submucosal turbinectomy. Α: Before the operation Β: At the end of the operation, the reduction of the turbinate size is obvious. The thin absorbable haemostatic sheet supports the operation site. No packs are used.
When soft tissue debulking is not enough and turbinate bone must also be removed, this can be done by means of the submucosal turbinectomy. Α: Before the operation Β: At the end of the operation, the reduction of the turbinate size is obvious. The thin absorbable haemostatic sheet supports the operation site. No packs are used.
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