Wand Malposition during Inferior Turbinate Coblation Using Rhinoscopy or External View

Abstract

Objectives: 1) Analyze differences in inferior turbinate coblation wand angles in correct and incorrect positions. 2) Determine whether rhinoscopy images of the coblation wand in the head of the inferior turbinate are adequate to determine distal tip position. 3) Determine whether viewing the coblation wand externally, such as is done by instructors during training, is adequate to determine distal tip position. Methods: Arthrocare Reflex Ultra 45 Plasma Wands were placed in inferior turbinates of cadaver specimens in three configurations: 1) ideal location for inferior turbinate reduction; 2) with distal tip where sphenopalatine artery (SPA) enters the nasal cavity; 3) with distal tip in nasal septum. Photos were taken of wand position from external views and an endoscopy view at the nasal vestibule. Angles from midline, the Frankfort horizontal line, and a mid-sagittal line were calculated under each condition. Images from the three conditions were shown to otolaryngologists to determine if the correct position could be selected. Results: Wand angles, in each dimension, varied an average of 12 degrees (SD 10.1 deg). Shifting the wand 12 degrees in any direction corresponds to 4mm motion of the proximal wand with the distal end moving 1cm. Providers trained in facial plastic surgery, rhinology, and sleep medicine identified the correct coblation wand position 33 percent of the time. Conclusions: Inferior turbinate coblation is a common office and operating room procedure. Wand malposition using an external viewpoint or rhinoscopy may result in suboptimal turbinate reduction or epistaxis. Placement verification may be beneficial.