Inferior Turbinate Reduction Surgery Research Articles

Comparison of Allergen Immunotherapy Alone and in Conjunction With Turbinate Surgery for Nasal Obstruction in Perennial Allergic Rhinitis Patients.

Nasal obstruction, triggered by allergic rhinitis, often does not resolve with allergen-specific immunotherapy (AIT) alone, thus inferior turbinate reduction surgery (ITR) may be required. This study aims to investigate the impact of combined treatment on nasal obstruction, as evidence is currently limited. A retrospective cohort study of perennial allergic rhinitis patients experiencing nasal obstruction and undergoing ≥12 months AIT was conducted. Two groups were derived, those undergoing AIT-with or without an ITR. Patient reported nasal obstruction (evaluated with questionnaires) and nasal airway function (Nasal Peak Inspiratory Flow [NPIF] and Nasal Airflow Resistance [NAR]) were monitored. The change from baseline to 12 months post-treatment in each group were compared. A total of 118 patients (33.71 ± 14.43 years, 41.5% female) were recruited, 72% had AIT and 28% AIT&ITR. At baseline, the AIT&ITR group had a higher level of nasal obstruction (>moderate%; 63.6% vs 52.9%, P = .048). Post treatment, AIT&ITR group reported greater reduction in nasal obstruction (>1 category change: 75.8% vs 48.2%, P = .002). Similarly, the AIT&ITR group had greater improvement in nasal function by NPIF (-13.9 ± 110.3 L/minute vs -3.4 ± 78.1 L/minute, P = .049) and NAR (-0.120 ± 0.342 Pa/cm³/second vs -0.093 ± 0.224 Pa/cm³/second, P = .050). Allergic rhinitis patients, with moderate to severe nasal obstruction, who undergo combined AIT&ITR have greater relief of nasal obstruction and improved airflow analysis compared to AIT alone.

Can oxymetazoline simulate the outcomes of septoplasty and inferior turbinate reduction surgery?

Inferior turbinate hypertrophy (ITH), with or without nasal septum deviation, is among the most common surgically correctable etiologies of nasal obstruction.1 The current challenge associated with surgical decision is twofold: 1) there are significant variabilities in individual nasal anamtomies as well as in surgical techniques; 2) there are few objective measures to identify which patients would benefit from surgery.2, 3 A patient's responsiveness to oxymetazoline has been often used as a proxy for surgical candidacy.3 Oxymetazoline is a selective α1 adrenergic receptor agonist and α2 adrenergic receptor partial agonist, which causes vasoconstriction and results in nasal decongestion since the soft tissue of the turbinates is rich in venous sinusoids and seromucinous glands. Yet despite the ubiquitous use of this bedside test, there are limited data that objectively compare the effect of oxymetazoline versus surgery on nasal morphology and aerodynamics, and whether such an approach could be used to predict patient outcomes. This study uses computational fluid dynamics (CFD) modeling to examine the changes in nasal aerodynamics and resistance in one patient after administration of oxymetazoline nasal spray as well as after inferior turbinate reduction surgery, to preliminarily investigate whether the changes in these factors are similar between the two and can corroborate the degree of symptomatic improvement. The patient is a 39-year-old male with moderate bilateral ITH and septal deviation resulting in nasal obstructive symptoms refractory to topical intranasal steroids. He denied history of chronic rhinosinusitis, allergies, head trauma, or autoimmune/connective tissue disorders. The patient completed the NOSE, SNOT-22, and Visual Analog Scales (VAS) for nasal obstruction (0: completely clear, 10: completely obstructed) immediately before his baseline computed tomography (CT) scan. To rule out placebo effect, a single-blinded sham test was performed with saline solution prior to oxymetazoline administration. Saline was topically applied via nasal spray followed by a 30 min rest and reassessment of symptoms (VAS and NOSE score). After the sham test, topical oxymetazoline spray was applied with symptom reassessment after a 30 min rest. A second CT scan then immediately followed. The patient ultimately underwent bilateral inferior turbinate reduction as well as minor septoplasty to remove a septal spur, with postoperative assessment after 8 weeks. Three-dimensional CFD models were constructed using the described method5 based on cone beam CT scans (3D Accuitomo 170, J. Morita USA, Inc.) at three time points: baseline, 30 min after oxymetazoline, and 8 weeks after surgery. Airflow patterns and velocity changes throughout the nasal airway were simulated under quasi-steady restful breathing conditions (15 Pa pressure drop between the nostrils and the nasal pharynx at a room air temperature of 20°C) using CFD software (ANSYS Fluent 19.2, Ansys, Inc, Canonsburg, PA). The numerical method and meshing protocol applied in this study have been previously validated against experimental measurements.4 The patient reported significant symptomatic improvement after both oxymetazoline and surgery. The NOSE score decreased from 80 at baseline and 80 after the sham test to 35 after oxymetazoline spray and 30 at 8 weeks after surgery. Likewise, VAS ratings of nasal obstruction decreased from 7 at baseline, to 6 after the sham test, 3 after oxymetazoline spray, and 2 after surgery. The SNOT-22 score decreased from 39 at baseline, to 9 at the post-surgery visit. Despite similar symptomatic outcomes, the aerodynamic effect of oxymetazoline was distinctly different and more pronounced than that of surgery. Post-oxymetazoline, nasal resistance was reduced by 56%, while average airflow velocity increased by 128% from baseline. Post-surgery, nasal resistance only reduced by 17%, while average airflow velocity increased by 21%. Peak mucosal heat flux increased 122% post-oxymetazoline versus 27% post-surgery as compared to baseline (Figure 1). Morphologically, oxymetazoline can affect the full length of inferior, middle, and superior turbinates, whereas the effect of surgery is limited to the surgical sites (Figure 2). The high velocity airflow is centered around the inferior portion of the middle turbinate post-oxymetazoline, while distributed towards the inferior turbinate post-surgery (Figure 2). One additional benefit of surgery may be the balancing of airflow between the two nasal cavities. At baseline, the patient's right nasal cavity had 4.55 times higher resistance than the left side. This reduced to 1.35 times after oxymetazoline administration and was nearly even (0.96) after surgery. This airflow-balancing effect may contribute to the marked improvement in airflow sensation post-surgery despite significantly better aerodynamic improvement post-oxymetazoline. This finding necessitates further study to confirm. Oxymetazoline and nasal airway surgery have comparable outcomes in relieving nasal obstructive symptoms. However, they appear to impact nasal morphology and aerodynamics very differently. Additional studies are warranted to rigorously test whether the responsiveness to oxymetazoline is a reliable predictor of satisfactory surgical outcomes. This study was supported by an investigator-initiated research grant by Bayer Health USA, Inc., to K.Z. The authors have no conflicts of interest to report.

A comparative study between cobblator and microdebrider assisted inferior turbinate reduction surgery

<p class="abstract"><strong>Background:</strong> Inferior turbinate hypertrophy (ITH) management includes medical and surgical line which reduces the size of the turbinate. The surgical line of management includes old partial and total turbinectomy to newer technique as submucous inferior turbinate reduction (ITR) using cobblation, microdebrider, radiofrequency ablation, diathermy, cryotherapy, and laser therapy.</p><p class="abstract"><strong>Methods:</strong> Our study was duration based prospective observational study conducted between August 2021 to August 2022 in department of otorhinolaryngology at our institute with total of 160 patients who have undergone turbinate reduction surgery during 1 year duration. Half number of patients have undergone microdebrider assisted submucous inferior turbinate reduction surgery (group A) and remaining half number have undergone cobblator assisted submucous Inferior turbinate reduction surgery (group B). Comparison of pre-operative and postoperative data of each surgical technique was the aim of our study. </p><p class="abstract"><strong>Results:</strong> On comparing the nasal obstruction symptom evaluation (NOSE) score using unpaired t test, between the two techniques on each follow up days respectively, it was found that cobblation provided better improvement than microdebrider on each day and the results were highly significant with p value <0.01. On comparing the pre-operative and post-operative (day 60) inferior turbinate size using paired t test, the result of the test was statistically significant with p value <0.01 in both nostrils using both the techniques.</p><p class="abstract"><strong>Conclusions:</strong> Submucosal inferior turbinate reduction surgery for ITH using either microdebrider or cobblator technique shown better improvement in terms of NOSE score improvement, Inferior turbinate size reduction, mucocilliary transit time improvement.</p><p class="abstract"> </p>

Autonomic reflex effect of the inferior turbinate outfracture or bipolar cauterization inferior turbinate reduction surgery

Autonomic reflex effect of the inferior turbinate outfracture or bipolar cauterization inferior turbinate reduction surgery

Nasal air conditioning following total inferior turbinectomy compared to inferior turbinoplasty – A computational fluid dynamics study

BackgroundThe aim of this study was to use computational fluid dynamics (CFD) to investigate the effects on nasal heat exchange and humidification of two different surgical techniques for reducing the inferior turbinate under different environmental conditions. MethodsVirtual surgery using two techniques of turbinate reduction was performed in eight nasal airway obstruction patients. Bilateral nasal airway models for each patient were compared: 1) Pre-operative 2) Post inferior turbinoplasty 3) Post total inferior turbinate resection (ITR). Two representative healthy models were included. Three different environmental conditions were investigated 1) ambient air 2) cold, dry air 3) hot, humid air. CFD modelling of airflow and conditioning was performed under steady-state, laminar, inspiratory conditions. FindingsNasal conditioning is significantly altered following inferior turbinate reduction surgery, particularly with ITR under cold, dry inspired air (CDA). The degree of impairment is minor under the simulated range of environmental conditions (temperature = 12–40 °C; relative humidity = 13–80%). Streams of significantly colder air are found in the nasopharynx and more prevalent under CDA in ITR. These are related to high velocity flow streams, which remain cool in their centre throughout the widened inferior nasal cavity. InterpretationReduced air-mucosal heat exchange and moisture carrying capacity occurs under cooler temperatures in patients following inferior turbinate surgery. The clinical impact in extremely cold and dry conditions in groups with poor baseline respiratory function, respiratory illness, or endurance athletes is of special interest.

Outcomes of microdebrider-assisted versus radiofrequency-assisted inferior turbinate reduction surgery: a systematic review and meta-analysis of interventional randomised studies.

The microdebrider technique was introduced in clinical practice to provide a better outcome in nasal obstruction caused by inferior turbinate hypertrophy. We conducted this systematic review to evaluate the effectiveness of this technique, by comparison with the radiofrequency-assisted modality. PubMed, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched to retrieve relevant randomised studies published prior to November 2019. Randomised Trials in English that studied the difference between the two techniques among adult patients were eligible for the current review. Data extraction and study inclusion were guided by PRISMA guidelines. The outcome measures were visual analogue scale (VAS, 0-10) for nasal obstruction, anterior active rhinomanometry, and acoustic rhinometry. A meta-analysis was carried out to quantify the difference between the two techni- ques, for each measured outcome. Seven randomised trials were included and quantitatively analysed in this meta-analysis. Our analysis revealed that the microdebrider-assisted technique demonstrated significantly better VAS (0-10) for nasal obstruction scores in early and late posto- perative follow-up. Whilst no difference was noted using the objective measurements (rhinomanometry and acoustic rhinometry) at early follow-up, microdebrider-assisted technique showed superior results in long-term follow-up, as evidenced using anterior active rhinomanometry. The microdebrider-assisted technique results in a better outcome, particularly in long-term follow-up, when compa- red with radiofrequency.

Vascular Anatomy of the Inferior Turbinate and Its Clinical Implications.

Published reports on the vascular anatomy of the inferior turbinate (IT) are limited. Historical papers report the IT artery as a tributary off the posterior lateral nasal artery (PLNA), but this has not been our clinical experience. The purpose of this study was to examine the arterial blood supply to and the branching pattern within the IT. We discuss this is the context of IT surgery and relate it to postoperative bleeding complication rates. Endoscopic dissection was performed on 16 cadaver heads (24 sides) to determine the origin of the IT artery. Intraoperative surgical videos were analyzed in 50 patients to uncover the vascular branching pattern within the IT. A retrospective review of bleeding complications in patients undergoing IT reduction surgery was also conducted. In 17 of 24 sides (70.8%), the IT artery arose either exclusively (54.2%) or partly (16.6%) off the descending palatine artery (DPA). As a branch off the DPA, the IT artery exited the pterygopalatine fossa through a foramen located 7.7 ± 3.0 mm from posterior edge of the IT, 8.4 ± 3.1 mm above the nasal floor and 1.6 ± 2.1 mm below the insertion of the IT bone onto the lateral nasal wall. The mean number of arteries cascading within the IT was 2.7 ± 0.5. Moreover, 112 patients underwent IT reduction surgery and 2 (1.8%) experienced postoperative epistaxis. The IT artery has major contributions from the DPA. Most commonly 3 arteries branch within the IT. Knowledge of this vascular anatomy may minimize bleeding associated with IT reduction surgery.

Long-Face Dentofacial Deformities: Occlusion and Facial Esthetic Surgical Outcomes

The purpose of this study was to document malocclusion and facial dysmorphology in a series of patients with long face (LF) and chronic obstructive nasal breathing before treatment and the outcomes after bimaxillary orthognathic, osseous genioplasty, and intranasal surgery. A retrospective cohort study of patients with LF undergoing bimaxillary, chin, and intranasal (septoplasty and inferior turbinate reduction) surgery was implemented. Predictor variables were grouped into demographic, anatomic, operative, and longitudinal follow-up categories. Primary outcome variables were the initial postoperative occlusion achieved (T2; 5weeks after surgery) and the occulsion maintained long-term (>2years after surgery). Six key occlusion parameters were assessed: overjet, overbite, coincidence of dental midlines, canine Angle classification, and molar vertical and transverse positions. The second outcome variable was the facial esthetic results. Photographs in 6 views were analyzed to document 7 facial contour characteristics. Seventy-eight patients met the inclusion criteria. Average age at surgery was 24years (range, 13 to 54yr). The study included 53 female patients (68%). Findings confirmed that occlusion after initial surgical healing (T2) met the objectives for all parameters in 97% of patients (76 of 78). Most (68 of 78; 87%) maintained a favorable anterior and posterior occlusion for each parameter studied long-term (mean, 5years 5months). Facial contour deformities at presentation included prominent nose (63%), flat cheekbones (96%), flat midface (96%), weak chin (91%), obtuse neck-to-chin angle (56%), wide lip separation (95%), and excess maxillary dental show (99%). Correction of all pretreatment facial contour deformities was confirmed in 92% of patients after surgery. Long face patients with higher preoperative body mass index levels were more likely to have residual facial dysmorphology after surgery (P=.0009). Using orthognathic surgery techniques, patients with LF dentofacial deformity achieved the planned occlusion and most maintained the corrected occlusion long-term. In unoperated patients with LF, a "facial esthetic type" was identified. Orthognathic surgery proved effective in correcting associated facial dysmorphology in most patients.

Identifying patients who may benefit from inferior turbinate reduction using computer simulations.

(1) To determine objective criteria to predict which patients may benefit most from inferior turbinate reduction surgery. (2) To test whether the site of turbinate reduction, either along the nasal floor (bottom resection) or along the septal side (medial resection), impacts the extent to which nasal resistance is reduced. Case series. Three-dimensional reconstructions of the nasal anatomy of five nasal airway obstruction patients were created based on presurgical computed tomography scans. Inferior turbinate reduction models were created for each patient using virtual surgery. Airflow, heat transfer, and humidity transport during inspiration were simulated using computational fluid dynamics (CFD). Nasal resistance curves revealed little to no difference between bottom resection and medial resection models. In two patients, little change was observed in nasal resistance after virtual inferior turbinate reduction, which was attributed to the narrowest cross-sections being restricted to the anterior nose (i.e., anterior to the inferior turbinate). The three patients whose nasal resistances decreased substantially after virtual inferior turbinate reduction had a narrower airspace in the turbinate region and higher nasal resistance presurgery. Nasal air conditioning capacity was more affected by medial resections. CFD simulations predicted no significant difference in the decrease in nasal resistance between virtual inferior turbinate reductions performed by bottom versus medial resection of the turbinate. However, bottom resections better preserved the calculated humidification efficiency. The simulations predicted that the greatest reduction in nasal resistance occurs in patients with the highest presurgical resistance in the turbinate region. 4.

The application of an ultrasonic bone aspirator for septoturbinoplasty.

The objectives of this study were to introduce the use of an ultrasonic bone aspirator (UBA; SONOPET [Mutoh Co, Ltd, Tokyo, Japan]) for septoturbinoplasty and to evaluate the efficacy and usefulness of this surgical procedure. This was a retrospective chart review. This study was performed at a university medical center. Of the 53 patients who underwent septoturbinoplasty from July to October 2013, 30 were operated on using a UBA and were enrolled in this study. Patients were followed for more than 6 months after surgery. Patterns of septal deviation and surgical results and complications were investigated by paranasal sinus computed tomography scans, nasal endoscopy, and acoustic rhinometry. Improvement of symptoms was measured using the Nasal Obstruction Symptom Evaluation scale. Patterns of bony septal deviation were classified as follows: localized septal bony spur or crest (n = 7), basal bony septal deviation (n = 9), posterior bony septal deviation (n = 8), bony spur with basal part deviation (n = 5), and basal and posterior bony septal deviation (n = 1).Twenty-six patients underwent septoplasty with bilateral inferior turbinate reduction surgery using either a microdebrider (n = 10) or a microdebrider with UBA (n = 16). Four patients underwent septoplasty with unilateral turbinate reduction surgery using a microdebrider and UBA. Based on nasal endoscopic findings after surgery, 24 patients had a straight septum, whereas 6 exhibited minimal remaining curvature. Subjective symptoms of nasal obstruction evaluated using the visual analog scale and the Nasal Obstruction Symptom Evaluation scale were improved in all patients. Surgery using a UBA increased minimal cross-sectional area and nasal volume change in patients. There were no significant complications related to UBA use such as saddle nose, bleeding, or septal perforation. Application of a UBA for septo-turbinate surgery is an easy, safe, and effective method that reduces the occurrence of common complications, such as septal perforation, delayed healing, infection, and bleeding. In addition, the UBA produces minimal thermal and mechanical injury to surrounding tissue and enables precise and incremental bone removal with continuous irrigation and suction. This tool allows for easy sculpting and reduction of bony architecture of the nasal cavity.

Inferior Turbinoplasty During Cosmetic Rhinoplasty

The sheer number of accepted inferior turbinoplasty techniques emphasizes the fact that there is no general agreement on which approach yields optimal results, nor are there data available that describes prevalent techniques in turbinate surgery among plastic surgeons. The aim of this study was to identify practice patterns among plastic surgeons who perform inferior turbinoplasty during rhinoplasty. Members of the American Society of Plastic Surgeons were invited to participate in an anonymous, Internet-based survey containing questions related to personal preferences and outcomes in inferior turbinate surgery. A total of 534 members of the American Society of Plastic Surgeons participated in the survey. Most (71.7%) trained in an independent plastic surgery program with prerequisite training in general surgery. More than half (50.6%) had more than 20 years of operative experience; only 15.2% reported performing greater than 40 rhinoplasties per year. The 5 most preferred inferior turbinate reduction techniques were outfracture of the turbinates (49.1%), partial turbinectomy (33.3%), submucous reduction via electrocautery (25.3%), submucous resection (23.6%), and electrocautery (22.5%). Fewer than 10% of the respondents reported the use of newer techniques such as radiofrequency thermal ablation (5.6%), use of the microdebrider (2.2%), laser cautery (1.1%), or cryosurgery (0.6%). Mucosal crusting and desiccation were the most frequently reported complications. The results of this survey provide insights into the current preferences in inferior turbinate reduction surgery. Plastic surgeons are performing more conventional methods of turbinate reduction rather than taking advantage of the many of the more novel technology-driven methods.

Inferior Turbinoplasty during Cosmetic Rhinoplasty

BACKGROUND The sheer number of accepted inferior turbinoplasty techniques emphasizes the fact that there is no general agreement on which approach yields optimal results, nor are there data available that describes prevalent techniques in turbinate surgery among plastic surgeons. OBJECTIVE The aim of this study was to identify practice patterns among plastic surgeons who perform inferior turbinoplasty during rhinoplasty. METHODS Members of the American Society of Plastic Surgeons were invited to participate in an anonymous, Internet-based survey containing questions related to personal preferences and outcomes in inferior turbinate surgery. RESULTS A total of 534 members of the American Society of Plastic Surgeons participated in the survey. Most (71.7%) trained in an independent plastic surgery program with prerequisite training in general surgery. More than half (50.6%) had more than 20 years of operative experience; only 15.2% reported performing greater than 40 rhinoplasties per year. The 5 most preferred inferior turbinate reduction techniques were outfracture of the turbinates (49.1%), partial turbinectomy (33.3%), submucous reduction via electrocautery (25.3%), submucous resection (23.6%), and electrocautery (22.5%). Fewer than 10% of the respondents reported the use of newer techniques such as radiofrequency thermal ablation (5.6%), use of the microdebrider (2.2%), laser cautery (1.1%), or cryosurgery (0.6%). Mucosal crusting and desiccation were the most frequently reported complications. CONCLUSIONS The results of this survey provide insights into the current preferences in inferior turbinate reduction surgery. Plastic surgeons are performing more conventional methods of turbinate reduction rather than taking advantage of the many of the more novel technology-driven methods.

CoblationA(r) inferior turbinate reduction: a long-term follow-up with subjective and objective assessment

This article presents long-term outcomes following Coblation® inferior turbinate reduction surgery (CITR) using both subjective and objective outcome measures in a cohort of patients with nasal obstruction secondary to enlarged inferior turbinate. Subjective assessment of the severity of nasal obstruction was assessed using a 100 mm visual analogue scale anchored by the descriptors 'nose completely clear' (0 mm) and 'nose completely blocked' (100 mm). Nasal conductance of airflow was measured by posterior rhinomanometry. Of the original cohort of 18 patients, 13 patients (76%) were available for follow-up at 32 months after surgery. The mean baseline nasal conductance was 248.6 cm3/s (range 2.5-614.8), which improved significantly (p=0.033) to 342.1 cm3/s (range 166.7-500) at 32 months post-operatively. Improvement in the subjective sensation of nasal obstruction was indicated by a lower VAS score compared to baseline. The mean pre-operative VAS was 72 mm (range 49-98), which improved to 53 mm (range 2-93) but this did not achieve statistical significance (10/13 patients scored improved airflow). This was a pilot study of the long-term outcomes of CITR. Despite the small study cohort, there appears to be sustained improvement in nasal conductance of air-flow up to 32 months follow-up. Although there was improvement in the subjective assessment of nasal obstruction, this did not achieve statistical significance.

Histopathological Changes After Coblation Inferior Turbinate Reduction

To assess the medium- to long-term histopathological changes after coblation (cold ablation) inferior turbinate (IT) reduction (CITR) surgery for refractory IT hypertrophy. Two-center, prospective, nonrandomized, controlled histological study. University-affiliated hospitals. The coblation-treated group included 22 samples from 16 men with IT hypertrophy in whom CITR had failed and who underwent endoscopically guided mucotomy. The control group included 18 samples from 14 men who had nasal obstruction due to refractory IT hypertrophy and who had undergone inferior turbinectomy. After processing the samples of both groups, we assessed the general histopathological features, the area fraction of various soft-tissue constituents, and the epithelial integrity. Qualitative analysis showed marked fibrosis and depletion of submucosal glands and venous sinusoids in the lamina propria after CITR. Compared with the control group, the coblation-treated group showed a significantly increased area fraction of connective tissue and a significantly decreased area fraction of submucosal glands and venous sinusoids (P < .001 for all 3 comparisons). A significantly decreased relative proportion of intact epithelium and a significantly increased relative proportion of partial epithelial shedding were also found in the coblation-treated group (P = .03 and P = .04, respectively). The long-term histological effects of CITR were significant fibrosis, glandular and venous sinusoid depletion, and partial epithelial shedding. The latter probably resulted from vascular damage, causing a reduction in epithelial perfusion. Questions remain concerning the long-term implications of the histopathological changes of CITR on nasal physiology.

The Histopathology of the Hypertrophic Inferior Turbinate

To analyze the quantitative and qualitative characteristics of the hypertrophic inferior turbinate (IT). A prospective, nonrandomized, controlled, morphometric study. University-affiliated hospital. Subjects Seventeen patients with refractory IT hypertrophy and 12 with normal ITs. Twenty ITs were removed from patients with refractory IT hypertrophy and 14 from patients with normal ITs. The soft tissue and bony elements and the relative proportions of the soft tissue constituents of the hypertrophic and normal ITs were measured and compared. The Bonferroni correction was used to adjust for multiple comparisons. Qualitative assessment was performed to assess possible pathologic changes in all IT tissues. The hypertrophic ITs were significantly wider. The medial mucosal layer, which thickened from a mean +/- SD of 1.39 +/- 0.28 mm to 2.53 +/- 0.56 mm (P</=.001), made the greatest contribution to the total increase in the width of the IT (64.4%). The enlargement in width of the lateral mucosal layer from 0.91 +/- 0.26 mm to 1.26 +/- 031 mm was of borderline statistical significance. The portion of the medial, lateral, and inferior layers of the lamina propria that houses inflammatory cells enlarged significantly in patients with IT hypertrophy compared with healthy control subjects. The relative proportion of the connective tissue, submucosal glands, and arteries remained unchanged, whereas that of venous sinusoids increased significantly in all aspects of the hypertrophic mucosa. Fibrosis, inflammation, and engorged venous sinusoids were noted in hypertrophic ITs, yet there was no evidence of tissue destruction. Understanding the histopathology of the hypertrophic IT is imperative for the development and management of IT reduction surgery.

Endoscopic potassium-titanyl-phosphate laser treatment for the reduction of hypertrophic inferior nasal turbinate.

This study investigated the efficacy of using the KTP/532 laser in endoscopic inferior turbinate reduction surgery. Potasium-titanyl-phosphate (KTP/532) laser is a useful tool in endoscopic intranasal operations, due to its outstanding capabilities in hemostasis, tissue penetration, and the maneuverability of its flexible transmission optic fiber. A total of 124 patients (male/female 73:51, mean age 38.7 +/- 12.3 years) with chronic hypertrophic rhinitis who received endoscopic KTP/532 laser inferior turbinate reduction surgery (7 Watts, continuous mode, 0.6-1-mm spots) were available for follow-up (mean follow-up period, 25.1 +/- 7.3 months). Medical records were retrospectively reviewed, and patients were interviewed with a questionnaire. The KTP/532 laser was excellent in relieving nose obstruction caused by inferior turbinate hypertrophy; 87% of patients reported improvement. The outcomes were less promising in reducing post-nasal drip; 12.9% reported only some improvement. Under intranasal endoscopy, the risk of postoperative bleeding and complication was low. The findings proved that, with the use of an endoscope, the KTP/532 laser appears to be an excellent alternative for treating hypertrophic inferior turbinate.

Inferior Turbinate Reduction Surgery in Children

We assessed the effectiveness and safety of surgical reduction of the inferior turbinate in 64 children, ages three to 15 years, who were operated on between January 1985 and November 1995. All patients/parents were interviewed and assessed by means of a questionnaire one to 10 years postoperatively. All patients had follow-up and were evaluated clinically at one and two weeks postoperatively. Long-term follow-up visits occurred at six, 12 and 24 months. Eighty-nine percent of the children/parents reported a sustained improvement in their nasal airways. No cases of serious postoperative hemorrhage, excessive dryness nor long-term crusting of the nose were observed or reported. We conclude that in the treatment of children with severe nasal obstruction, surgical reduction of the inferior turbinate is a safe and effective operation, alone or in combination with other airway procedures, and may increase the effectiveness of subsequent medical management.