Microdebrider-assisted Turbinoplasty Research Articles

Radiofrequency Ablation and Microdebrider-Assisted Turbinoplasty: 5-Year Postoperative Outcomes

Background and Objectives: Turbinoplasty may be an option in patients with persistent symptoms of allergic rhinitis (AR) despite adequate medication. The two most frequently used surgical techniques for turbinoplasty are radiofrequency ablation and microdebriderassisted turbinoplasty. This study compared the outcomes of these two surgical techniques and assessed the long-term treatment effects.Methods: This study included patients with AR who underwent turbinoplasty between January 2010 and June 2017. We examined the medication scores, overall treatment satisfaction scores, and medical records. Based on the type of surgery, patients were classified into microdebrider and coblator groups. A telephone survey was conducted to collect data on the 5-year post-treatment efficacy parameters. Scores for allergic symptoms, prescription medicines taken after surgery, and general satisfaction were compared.Results: Of the total 241 patients, 192 (79.7%) and 49 (20.3%) underwent microdebrider-assisted turbinoplasty and radiofrequency ablation turbinoplasty, respectively. Both the microdebrider and coblator groups showed remarkable improvements in AR symptoms at the 5-year follow-up (p<0.001). Although the degree of symptom improvement did not differ significantly between the two groups, the coblator group did show significant improvements in medication scores when compared with the microdebrider group (p<0.05), and there were significant differences in postoperative satisfaction scores between the two groups.Conclusion: In terms of 5-year postoperative outcomes, radiofrequency-ablation turbinoplasty and microdebrider-assisted turbinoplasty were equally beneficial for reducing nasal symptoms and enhancing medication ratings in patients with AR.

Surgical Management of Inferior Turbinate Hypertrophy in the Era of Widespread Communicable Disease.

Inferior turbinate reduction procedures have been performed for decades. After significant evolution, turbinoplasty and other mucosal-sparing techniques have become the main method to successfully reduce turbinate hypertrophy. The debate of which technique produces the most effective and durable outcomes is ongoing. During this critical era of widespread communicable diseases, including but not limited to COVID-19, HIV, and hepatitis, additional attention is necessary to balance outcomes with a degree of generation of airborne particles when selecting a technique. This review article aims to identify the optimal method for inferior turbinate reduction that weighs both outcomes and aerosol production. The MEDLINE database was searched to discover relevant publications through August 2022. Key search terms included inferior turbinate hypertrophy, turbinate reduction surgery, turbinoplasty methods, surgical management of turbinate hypertrophy, surgical aerosol generation, COVID-19 surgery, surgery smoke plume, SARS-CoV-2 transmission during surgery, and nasal procedures COVID-19 aerosols. Surgical management of the inferior turbinates includes radiofrequency ablation (RFA), microdebrider-assisted turbinoplasty (MAIT), electrocautery, laser, and ultrasound. Piezo-assisted turbinoplasty and a turbinate-specific coblation wand are new additions to the literature. All techniques appear to improve patient symptoms of nasal obstruction. MAIT and RFA are comparable, although MAIT demonstrated better long-term outcomes in some studies and appears to generate fewer airborne particles. Studies evaluating the production of aerosols due to RFA are lacking. Ultrasound outcomes are also excellent and generate no aerosols, but the technique has not been compared against the microdebrider. Electrocautery can result in increased pain and crusting for patients and causes the highest amount of aerosols. Deficiencies of current studies, including a lack of comparison of aerosol generation, duration of follow-up, omission of outfracture, and inadequate randomized controlled trials among existing and new techniques, have limited the identification of the best inferior turbinate reduction method. Given the durability of MAIT and its minimal aerosol production, it can be reinforced as the most sensible technique until further evidence is available.

Inferior Turbinate Hypertrophy: A Comparison of Surgical Techniques.

Introduction Nasal obstruction is one of the most frequently reported symptoms in clinical practice. The second most common causeof nasal obstruction is inferior turbinate hypertrophy, a nasal pathology for which surgical treatmentis often required. This study aims to determine the most effective surgical method in patients with inferior turbinate hypertrophy (ITH). Materials and methods The studywas performed from September 2018 to October 2019 in the Otolaryngology-Head and Neck Surgery Department of the Evangelismos Hospital of Athens.The study population comprised 205 patients that underwent surgery and were monitored in the hospital.Radiofrequency ablation (RFA) was the method used in 73 patients, 68 patients were treated with the microdebrider-assisted turbinoplasty (MAT), and the remaining 64 patients were operated on using electrocautery (EC). Following surgery,postoperative complications were assessed and quantified. Results Overall, 205 patients underwent surgery. The first group (n=73) was operated on using radiofrequency ablation and had a complication rate of 30.1%. Out of 73patients, 51 recovered without complications. The remaining 22 had complications, consisting of 16patients with bleeding and six with postnasal drip. The second group (n=68) was treated using the microdebrider method. The complication rate was 26.5%, where 50 patients did not present with any symptoms post-operativelyand 18 exhibited symptoms. Specifically, postnasal drip was more prevalent with this method as all 18 patients showed postnasal drip as their complication. The third group (n=64) was treated with electrocautery. Patients in this group had the most complications (n=24),16 were attributed to postnasal drip and eight to infections, treated promptly with oral antibiotics. The complication rate using this method was 37.5%. Conclusion In our study, the microdebrider-assisted turbinoplasty offered the lowest complication rate, followed by radiofrequency ablation and electrocautery. However, all three methods managed to alleviate the nasal obstruction and treat inferior turbinate hypertrophy. More research is needed as a lack of consensus remains regarding the optimal surgical technique for lower turbinate hypertrophy.

Effectiveness of submucosal turbinoplasty in refractory obstructive rhinitis: a prospective comparative trial.

Refractory inferior turbinate hypertrophy requires a surgical approach to address symptomatic complaints. Submucosal approaches demonstrated their efficacy in restoring respiratory function and respecting the nasal mucosa. Microdebrider-assisted turbinoplasty (MAT) tools effectively reduces the soft tissue, exploiting a very different principle from the kinetic energy of radiofrequency. Thus, we aimed to compare the microdebrider-assisted turbinoplasty and the quantum molecular resonance (QMR) to assess patients' perspectives and respiratory outcomes. Subjects with persistent bilateral nasal blockage due to inferior turbinates hypertrophy were prospectively recruited from the University Medical Center. We randomly assigned the patients to each treatment and performed symptom evaluation via the visual analog score and endoscopic assessment at baseline and 30-, 90-, and 180-day post-treatment. Seventy participants completed the evaluations, 35 in MAT and 35 in the QMR group. Nasal complaints were significantly reduced after 1month using both methods. Although the MAT group reported higher postoperative bleeding and edema than QMR group, similar significant reductions were seen for turbinate size at long-term follow-up. Conversely, the MAT group reported greater VAS outcomes than QMR from the first postoperative month. In addition, MAT showed a longer operating time, although this difference was not statistically significant (p < 0.05). MAT allows effective control of nasal symptoms by reducing the size of turbinates in patients with lower turbinate hypertrophy. Although QMR may cause fewer postoperative complications, functional results are comparable to long-term follow-up.

COMPARISON OF MICRODEBRIDER - ASSISTED TURBINOPLASTY VERSUS ENDOSCOPIC PARTIAL TURBINECTOMY IN CASES OF INFERIOR TURBINATE HYPERTROPHY IN ALLERGIC RHINITIS PATIENTS

Objective: To compare microdebrider-assisted turbinoplasty versus endoscopic partial turbinectomy in cases of inferior turbinate hypertrophy in allergic rhinitis patients in terms of relief/improvement of nasal obstruction, post operative bleeding, crusting and synechie formation.&#x0D; Study Design: Quasi experimental study.&#x0D; Place and Duration of Study: Combined Military Hospital Mardan and Combined Military Hospital Malir, from Jan 2019 to Jan 2020.&#x0D; Methodology: A total of 90 patients of allergic rhinitis with severe nasal obstruction due to bilateral inferior turbinate hypertrophy fulfilling the inclusion exclusion criteria were selected. Cases were randomly divided into two groups of 45 each. Group A cases underwent microdebrider assisted turbinoplasty and Group B cases underwent partial turbinectomy via endoscpic approach. They were comparedin terms of post op bleeding, relief of nasal obstruction, post op crusting &amp; synechie/adhesions. All the data was entered on SPSS-17 and analyzed.&#x0D; Results: Out of 90 cases, there were 43 (47.8%) females and 47 (52.2%) males with age range from 15-65, mean age 37.68 ± 11.56 Years. There was only 1 case of post op bleeding after microdebrider assisted turbinoplasty requiring nasal packing in contrast to 6 cases of post op bleeding after endoscopic partial turbinectomy. On one month post op visit, there was no case of nasal crusting in turbinoplasty group in contrast to 7 of mild and 1 of moderate crusting &amp; 3 synechie/adhesions in endoscopic partial turbinectomy group.&#x0D; Conclusion: Microdebrider-assisted turbinoplasty is associated with less post operative bleeding and synechie formation as compared to endoscopic turbinectomy.

Cadaveric Simulation of Endoscopic Endonasal Procedures: Analysis of Droplet Splatter Patterns During the COVID-19 Pandemic.

ObjectiveThe primary mode of viral transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is thought to occur through the spread of respiratory droplets. The objective of this study was to investigate droplet and splatter patterns resulting from common endoscopic endonasal procedures.Study DesignCadaver simulation series.SettingDedicated surgical laboratory.Subjects and MethodsAfter instilling cadaver head specimens (n = 2) with fluorescein solution, endoscopic endonasal procedures were systematically performed to evaluate the quantity, size, and distance of droplets and splatter following each experimental condition.ResultsThere were no observable fluorescein droplets or splatter noted in the measured surgical field in any direction after nasal endoscopy, septoplasty with microdebrider-assisted turbinoplasty, cold-steel functional endoscopic sinus surgery (FESS), and all experimental conditions using an ultrasonic aspirator. Limited droplet spread was noted with microdebrider FESS (2 droplets, <1 mm in size, within 10 cm), drilling of the sphenoid rostrum with a diamond burr (8, <1 mm, 12 cm), and drilling of the frontal beak with a cutting burr (5, <1 mm, 9 cm); however, the use of concurrent suction while drilling resulted in no droplets or splatter. The control condition of external activation of the drill resulted in gross contamination (11, 2 cm, 13 cm).ConclusionOur results indicate that there is very little droplet generation from routine rhinologic procedures. The droplet generation from drilling was mitigated with the use of concurrent suction. Extreme caution should be used to avoid activating powered instrumentation outside of the nasal cavity, which was found to cause droplet contamination.

Coblation versus microdebrider-assisted turbinoplasty for endoscopic inferior turbinates reduction

ObjectivePatients suffering from persistent inferior turbinates hypertrophy refractory to medical treatments require surgical intervention where the main aim is symptomatic relief without any complications. Extraturbinoplasty is one of the preferred procedures for turbinate reduction due to its efficacy in freeing up nasal space by removing the obstructing soft tissue and bone while preserving the turbinate mucosa. We sought to evaluate the effectiveness and safety of microdebrider assisted turbinoplasty (MAT) and coblation assisted turbinoplasty (CAT) performed as an extraturbinoplasty procedure. MethodsA prospective randomized comparative trial was conducted among patients with bilateral nasal blockage secondary to inferior turbinates hypertrophy. Patients were randomly assigned to MAT or CAT. An extraturbinal medial flap turbinoplasty was performed for both techniques. Symptom assessment was based on the visual analogue score for nasal obstruction, sneezing, rhinorrhea, headache and hyposmia. Turbinate size, edema and secretions were assessed by nasoendoscopic examination. The assessments were done preoperatively, at 1st postoperative week, 2nd and 3rd postoperative months. Postoperative morbidity like pain, bleeding, crusting and synechiae were documented. The clinical outcomes of both techniques were analyzed using repeated measures ANOVA. ResultsA total of 33 participants were recruited, 17 patients randomized for MAT and 16 patients for CAT. Nasal obstruction, discharge, sneezing, headache and hyposmia significantly reduced from 1st week until 3 months for both procedures. Similar significant reductions were seen for turbinate size, edema and secretions. However, there was no significant difference in symptoms and turbinate size reduction were seen between both groups at the first postoperative week, 2nd and 3rd postoperative months. There was significant longer operating time for CAT when compared to MAT (p = 0.001). The postoperative complications of bleeding, crusting and synechiae did not occur in both groups. ConclusionBoth MAT and CAT were equally effective in improving nasal symptoms and achieving turbinate size reduction in patients with inferior turbinate hypertrophy. Both MAT and CAT offer maximal relieve in patients experiencing inferior turbinates hypertrophy by removing the hypertrophied soft tissue together with the turbinate bone without any complications.

Comparison of Radiofrequency and Microdebrider-Assisted Turbinoplasty for Treatment of Isolated Inferior Turbinate Hypertrophy

Comparison of Radiofrequency and Microdebrider-Assisted Turbinoplasty for Treatment of Isolated Inferior Turbinate Hypertrophy

Assessment of safety and efficacy of extraturbinal microdebrider-assisted turbinoplasty versus partial inferior turbinectomy

ObjectiveThe aim was to compare the extraturbinal microdebrider-assisted turbinoplasty (MAT) with the partial inferior turbinectomy (PIT) based on subjective and objective parameters.Patients and MethodsA total of 18 patients with nasal obstruction owing to bilateral hypertrophied inferior turbinates were included in this study. All patients underwent extraturbinal MAT on one side of the nose and PIT on the other side in alternate manner. The patients were blinded to the technique used. This is a prospective blinded randomized trial was conducted. The study was conducted at a tertiary referral hospital.Main outcome measuresOperative time, blood loss, subjective improvement of the nasal obstruction, degree of intranasal crustations, and degree of synechiae formation were the main outcomes recorded.ResultsThe operative time and intraoperative blood loss were less in the extraturbinal MAT compared with PIT. At 2 weeks postoperatively, the sides with MAT had significantly better relief of nasal obstruction (P=0.007), less degree of nasal pain (P=0.002), less crustations (P=0.010), and better tissue healing (P =0.010) than sides with PIT. At 1 and 3 months postoperatively, the sides with MAT had statistically significant less crustations (P=0.040 and 0.032, respectively) and better tissue healing (P=0.010 and 0.010, respectively) compared with the sides with PIT; however, there were no statistically significant differences regarding relief of nasal obstruction and degree of nasal pain.ConclusionsExtraturbinal microdebrider-assisted inferior turbinoplasty is more effective and safe compared with PIT, especially in short-term follow-up periods.

Comparison of Radiofrequency Thermal Ablation and Microdebrider-Assisted Turbinoplasty in Inferior Turbinate Hypertrophy: A Prospective, Randomized, and Clinical Study.

To compare the effectiveness of radiofrequency thermal ablation with those of microdebrider-assisted turbinoplasty, we designed a prospective, randomized clinical study. Forty patients suffering from nasal obstruction due to bilateral inferior turbinate hypertrophy were enrolled. Half of the patients were operated by radiofrequency thermal ablation, while the other half underwent microdebrider-assisted turbinoplasty. The outcomes of both techniques were compared in terms of symptomatology, nasal patency, and mucociliary transport. A statistically significant difference existed between the two groups with respect to nasal obstruction and the frequency of obstruction at the first post-operative week and first and third post-operative months (p<0.05). Rhinomanometry detected a significant decrease in nasal resistance values in both surgical groups compared to the preoperative values. The mucociliary transport time was significantly prolonged in the first postoperative week and first postoperative month in microdebrider-assisted inferior turbinoplasty group. Both radiofrequency thermal ablation and microdebrider-assisted turbinoplasty are effective techniques for treating inferior turbinate hypertrophy. The treatment modality should be individually determined, and parameters such as tissue healing, volume reduction, and mucociliary activity must be taken into account.

Ultrastructural regenerating features of nasal mucosa following microdebrider-assisted turbinoplasty are related to clinical recovery.

Background The nasal mucosa plays a key role in conditioning the inhaled air and in regulating the immune response. These functions led many authors to recommend mucosal sparing techniques for the surgical management of inferior turbinate hypertrophy. However, the histological modifications of chronic diseases retain the inflammatory activity and prevent the nasal physiology restoration. It has been proved that the basal cells of the nasal mucosa are able to proliferate and to repair after cold-knife incision. The aim of this study was to demonstrate that the healing process after removal of the inferior turbinate mucosa with cold techniques results in a complete structural restoration.MethodsA prospective study was performed in 18 patients who underwent Microdebrider inferior turbinoplasty (cold technique). Subjective and objective improvement of nasal patency was evaluated with visual analogue scale, rhinomanometry, videoendoscopy and mucociliary transport test. Pre- and post-operative biopsy specimens were taken from 7 patients to evaluate the healing process. Two samples were taken from two healthy patients as control. The specimens were processed for transmission electron microscopy analysis.ResultsVideoendoscopy showed reduction of lower turbinate after surgery. Nasal patency augmented and no adverse consequences were observed. After 4 months the nasal mucosa showed normal appearance, with restoration of the pseudostratified ciliated pattern, intercellular connections and normal cellular morphology. Fibrosis and submucosal edema disappeared. At longer time after operation (4 years) clinical improvement was confirmed.ConclusionsThe total removal of the nasal mucosa with cold techniques results in a complete restoration of the normal structure and permanent resolution of the chronic inflammation typical of hypertrophic rhinopathy.

Microdebrider-assisted turbinoplasty against submucosal cauterization in inferior turbinate hypertrophy

Objective This study was carried out to compare postoperative outcomes between microdebrider-assisted turbinoplasty and submucosal cauterization (diathermy) in the treatment of chronic inferior turbinate hypertrophy using subjective and objective criteria. Background Chronic nasal obstruction is one of the most common symptoms in otorhinolaryngology, and hypertrophy of the inferior turbinates is the most frequent etiology. Patients and methods This prospective study was carried out over 25 patients with nasal obstruction and hypertrophied turbinate mucosa refractory to medical treatment. All patients enrolled in the present prospective randomized study were subjected to microdebrider-assisted turbinoplasty on the right side (group A operation) and a submucosal cauterization on the left side (group B operation). Postoperative changes in the degree of nasal obstruction, nasal discharge, and crustations were evaluated at 1 week, 1 month, and 6 months by nasal endoscopy. The patient satisfaction score was evaluated at 6 months postoperatively. Rhinomanometric measurement was also performed preoperatively and at 6 months postoperatively for objective comparison. Results Microdebrider-assisted turbinoplasty was statistically better in comparison with submucosal cauterization regarding postoperative nasal obstruction at 1 month (P = 0.025) and 6 months (P = 0.049), nasal crustations at 1 month (P = 0.004) and 6 months (P = 0.017), postoperative patient satisfaction at 6 months (P = 0.042), and rhinomanometric measurement at 6 months (P = 0.001). There was improvement of nasal discharge and headache with no statistically significant difference between both groups (P ≥ 0.05). Conclusion Microdebrider-assisted turbinoplasty is more effective and satisfactory than submucosal cauterization in relieving nasal obstruction subjectively and objectively.

Coblation vs Microdebrider-assisted Inferior Turbinoplasty

ABSTRACT Aim The aim of this study is to compare the effectiveness of coblation and microdebrider-assisted turbinoplasty in reducing nasal obstruction due to inferior turbinate hypertrophy (ITH). Background A comprehensive search of articles in English language was performed in PubMed using the keywords coblation turbinoplasty, coblation inferior turbinate reduction, microdebrider turbinoplasty, microdebrider assisted inferior turbinate reduction. Review results Primary search yielded 41 results with only two fulfilling the inclusion and exclusion criteria. In both studies, patients were assessed objectively as well as subjectively. Improvement in nasal obstruction was similar in both coblation and microdebrider groups up to 6 months of follow-up in both studies. However, in the study by Lee and Lee (2006) at 12 months postoperative follow-up, microdebrider-assisted turbinoplasty patients showed a better improvement in nasal obstruction both objectively on acoustic rhinometry and subjectively as compared with the coblation group (p &lt; 0.05). Conclusion Despite getting better results with microdebriderassisted turbinoplasty in one of the study, it can be safely concluded that longer postsurgical follow-up period with bigger sample size is required to adequately comment on the extra benefit offered by either coblation or microdebrider. Clinical significance As and when further research is planned on comparing benefits of different powered instruments for turbinate reduction, it will be wise to prolong the follow-up period with increased sample size. How to cite this article Kumar A, Goyal A, Singh RK. Coblation vs Microdebrider-assisted Inferior Turbinoplasty. Int J Otorhinolaryngol Clin 2016;8(2):51-52.

Surgical treatment for allergic rhinitis

Allergic rhinitis refractory to medical therapy may be challenging. Inferior turbinate hypertrophy has been suggested as a major cause of nasal obstruction. In addition, nasal septal deviation and chronic rhinosinusitis are possible causes. Various procedures exist for surgical reduction of inferior turbinate volume, including lateral out fracture, partial turbinectomy, submucosal resection, laserassisted turbinoplasty, radiofrequency-assisted turbinoplasty, and microdebrider-assisted turbinoplasty. In recent years, conservative turbinate surgery has been widely applied to decrease the risk of complications such as empty nose syndrome, crust formation, osteitis, and synechia. In some cases, septoplasty would be an important treatment method for allergic rhinitis when patients have coexisting nasal septal deviation. Recently, highly selective neurectomy to reduce the function of inferior turbinate is being implemented. Standard surgical treatment for allergic rhinitis has not been established, But a variety of surgery for patients who do not respond to appropriate medication can help relieve allergic symptoms. Because surgical management for allergic rhinitis may cause troublesome complications, these effective but invasive procedures should be chosen carefully. (���������������������������(���������� �0���

Comparative study of management of inferior turbinate hypertrophy using turbinoplasty assisted by microdebrider or 980 nm diode laser

This study aimed to compare the outcomes of turbinoplasty assisted by microdebrider and by diode laser (980 nm wavelength). Forty patients suffering from bilateral nasal obstruction were randomly divided into two equal groups. One group was managed with microdebrider-assisted turbinoplasty and the other with diode laser assisted turbinoplasty. The patients were followed up for six months post-operatively. After six months, total success rates were 90 per cent for the microdebrider group and 85 per cent for the diode laser group. There were no significant differences between the two groups regarding success rate, post-operative complications or operative time. These two techniques are equally safe, reliable, successful and non-invasive.