Submucosal Turbinectomy Research Articles

Submucosal Turbinectomy with Posterior Nasal Neurectomy as Day Surgery under Local Anesthesia

通年性アレルギー性鼻炎に対する粘膜下下鼻甲介骨切除術・後鼻神経末梢枝切断術の長期成績, 合併症, 安全性を評価し, 本術式の有効性および日帰り局所麻酔下で行うことが可能かを検討した. 本術式を施行し3～16年経過した101例のアンケートによる回答では, くしゃみ79%, 鼻汁83%, 鼻閉97%, 日常生活の支障度89%の有効率であり75%の症例に効果の持続性を認めた. 術後出血の頻度は0.6%と少なく, 過去2年ではシアノアクリレート注入酸化セルロースの留置により出血例は認めていない. 長期合併症でも日常生活に支障を来すような重篤なものは認めなかった. 局所麻酔下においても術中疼痛は軽度で, 術中出血は少なく, 手術時間も短く, 粘膜下下鼻甲介骨切除術・後鼻神経末梢枝切断術は局所麻酔下の日帰り手術で施行し得ると考えられた.

Long-term effectiveness, safety, and quality of life outcomes following endoscopic posterior nasal neurectomy with submucosal turbinectomy for the treatment of intractable severe chronic rhinitis

ObjectiveIn recent decades, posterior nasal neurectomy (PNN) with submucosal inferior turbinectomy (ST) has been increasingly used for the treatment of intractable severe rhinitis; however, to the best of our knowledge, there have been few studies regarding its long-term therapeutic effects or its influence on patient quality of life (QOL). Therefore, this study examined the long-term therapeutic effects in patients who underwent PNN with ST, as well as their QOL and medication use after surgery. MethodsThis retrospective cohort study initially included 16 consecutive patients who underwent PNN with ST from January 2010 to December 2011. Ten of the 16 patients participated in a paper-based survey questionnaire between June 2018 and November 2018; the responses of these 10 patients were used for analysis in this study. To clarify the effects of surgical treatment on symptoms, QOL, and medication status, data recorded before and 3 months after surgery were compared with data recorded at 8 years after surgery using the Japan Rhinoconjunctivitis Quality of Life Questionnaire No. 1 and Classification of the Severity of Allergic Rhinitis Symptoms I and II. ResultsNasal symptoms including runny nose and nasal congestion, medication score, respective total symptoms medication scores (i.e., combined average total symptoms score and medication score), and the scores of troubles with daily life and total QOL were significantly improved at 3 months and 8 years after surgery, compared with before surgery; scores were not significantly worsened at 8 years after surgery, compared with 3 months after surgery. In addition, there were no adverse events requiring treatment after surgery. ConclusionOur findings suggest that PNN with ST is effective and safe for long-term treatment of severe chronic rhinitis symptoms, as well as reduction of medication use and improvement of QOL.

Quantitative Clinical Analysis of Posterior Nasal Neurectomy with Submucosal Turbinectomy: Effects, Side-Effects and Surgical Indications

Quantitative Clinical Analysis of Posterior Nasal Neurectomy with Submucosal Turbinectomy: Effects, Side-Effects and Surgical Indications

Effects of surgical treatment of hypertrophic turbinates on the nasal obstruction and the quality of life

PurposeChronic hyperplasia of the inferior nasal concha is accompanied by a nasal obstruction; however, there is no standardised surgical treatment for this condition. Here, we compared the outcome of three surgical techniques frequently used to treat the hyperplasia of inferior turbinates: turbinectomy with lateralization, submucosal electrocautery and laser cautery additional to septoplasty. Materials and methodsOne hundred and nine patients participated in this prospective randomized study upon signing written consent. The subjects were randomly assigned to one of three intervention groups: 1) submucosal turbinectomy with lateralization, 2) submucosal electrocautery or 3) laser cautery. All groups were followed-up for up to 6months after surgical intervention. During the four follow-up appointments, the outcomes were measured with the modified German version of Sino-Nasal Outcome Test 20 questionnaire. In addition, the nasal breathing and the absolute nasal flow rates and respective mucosal component were determined by the anterior rhinomanometry. ResultsFollowing surgery, the subjective and objective nasal obstruction decreased significantly in all three groups. Moreover, the subjective symptoms measured by modified Sino-Nasal Outcome Test 20 improved significantly, although there were some temporal differences between groups regarding subjective nasal obstruction, ear pressure, nasal discomfort, daytime fatigue, cough and dry mouth. The mucosal component of nasal congestion decreased significantly after surgery. ConclusionsAll surgical techniques used to reduce the conchae mucosa led to a significant improvement in the objective and subjective nasal breathing and the quality of life. Septoplastic reduction proved to be of additional benefit.

Comparison of Voice Quality Between Patients Who Underwent Inferior Turbinoplasty or Radiofrequency Cauterization

The aim of this study was to analyze and compare the vocal quality in patients who underwent either submucosal turbinectomy or radiofrequency cauterization. In this study, we enrolled 60 patients diagnosed with inferior concha hypertrophy. These patients were divided into two groups by using computer program "Research Randomizer." Of the 60 patients, 30 underwent submucosal inferior turbinoplasty and 30 underwent radiofrequency cauterization. The control group was composed of 30 healthy adults with no nasal or upper aerodigestive system pathology. The patients were checked at weeks 1, 2, and 4. Voice records were taken before the procedure and at week 4 postprocedure. The mean age of patients in the inferior turbinoplasty group was 29.4 years (range: 19-42 years); in the radiofrequency group, it was 30.30 years (range: 18-50 years). There was no statistical difference in age between groups. In the inferior turbinoplasty group, there were 16 male and 14 female patients, and in the radiofrequency group, there were 13 male and 17 female patients. There was no significant difference in the number of males and females between groups. Voice professionals, especially singers, actors, and actresses, should be informed about possible voice changes before undergoing endonasal surgery because these individuals are more sensitive to changes in resonance organs. We believe that voice quality should be regarded as a highly important parameter when measuring the success of endonasal surgery.

下鼻甲介粘膜下経由上顎洞篩骨洞手術変法

In 1993, in the Journal of the Oto-Rhino-Laryngological Society of Japan, the authors published an endoscopic endonasal approach to surgery for chronic sinusitis, performing a transsubmucosal maxillectomy, ethmoidectomy and sphenoidectomy through the inferior turbinate, which the authors tentatively termed "swinging of the nasolacrimal duct and inferior turbinate." With the original technique, some bony structure was left partially exposed during resection of the mucosa in some patients, who suffered from postoperative crust formation. This technique thus required improvement. To solve this problem, the authors made an antero-posterior incision along the inferior turbinate during submucosal turbinectomy. This technique has solved most of the problems and greatly reduced postoperative crust formation, thereby considerably reducing the time for postoperative wound healing as compared with that seen with the original technique. The authors report herein on this surgical technique and indication, an improvement on the original method.

Resection of peripheral branches of the posterior nasal nerve compared to conventional posterior neurectomy in severe allergic rhinitis

Transnasal resection of the posterior nasal nerve (TRPN) is the surgical procedure for drug therapy-resistant, intractable allergic rhinitis (AR). Submucous inferior turbinectomy also improves nasal symptoms in severe AR. Surgical injury to this peripheral nerve fibre may be the major cause of the decrease in allergic symptoms. During submucous turbinectomy, we have identified the peripheral branches of the posterior nasal nerve in the inferior turbinate and resected them (SRPN). The aim of this study was to evaluate the therapeutic effects of turbinoplasty with SRPN in severe AR. Improvements in subjective symptoms were compared between 13 patients who underwent SRPN with turbinoplasty (Group 1) and 11 who underwent TRPN combined with turbinoplasty and SRPN (Group 2) by retrospective chart review. Pre- and postoperative sneezing, rhinorrhea, and nasal obstruction were evaluated with questionnaires. Postoperative complications and drug therapy before and after surgery were investigated. All symptoms improved postoperatively in both groups, with no significant differences in the improvements in nasal symptom scores between the groups. SRPN combined with submucosal turbinectomy was shown to be a safe, useful, and efficient approach to patients with AR unresponsive to medical therapy. Although this is a short-term study, the results of this study suggest that SRPN represents one of the treatment options for intractable AR.

Submucous turbinectomy combined with posterior nasal neurectomy in the management of severe allergic rhinitis: Clinical outcomes and local cytokine changes

Objectives Submucous resection of the inferior turbinate is one of the recommended methods to alleviate nasal symptoms in patients with severe allergic rhinitis patients in terms of postoperative results and preservation of nasal function. Posterior nasal neurectomy, recently developed by Kikawada, is a novel method to selectively cut the neural bundles out from the sphenopalatine foramen and to diminish the complaints of hypersecretion. This study was carried to examine the clinical effectiveness and changes in local cytokine levels of this combined surgical procedure. Methods Twenty-three patients with severe perennial allergic rhinitis underwent submucous turbinectomy combined with posterior nasal neurectomy under general anesthesia. The patients’ subjective nasal symptoms were examined at each visit. The levels of interleukin-5 (IL-5), eotaxin and regulated on activation, normal T cell expressed and secreted (RANTES) in nasal lavages were measured before and 6 month after surgery. Nasal mucosa of the inferior turbinate was also obtained for histopathological examination in some cases. Results The mean symptom scores for sneeze, rhinorrhea, nasal obstruction, and total severity were all statistically decreased after surgery. Therapeutic effects continued to be apparent as long as 3 years after surgery. The mean levels of both IL-5 and eotaxin significantly decreased after surgery, but that of RANTES remained unchanged. Histopathological examination revealed that the number of inflammatory cells and nasal glands markedly reduced in lamina propria and the epithelial layer became covered with stratified columnar cells. Conclusion Submucosal turbinectomy with posterior nasal neurectomy has remarkably improved subjective nasal symptoms in patients with severe allergic rhinitis on a long-term follow-up basis. The present study also demonstrates that the clinical effectiveness of the procedure is accompanied by decreases in local inflammatory cell infiltration and the related cytokine production.

鼻腔サルコイドーシス例

Although sarcoidosis is a systemic disease, the involvement of the nasal cavity is fairly uncommon. We present a 27-year-old female whose final diagnosis was nasal sarcoidosis. Nasal obstruction was the sole symptom at her first presentation. She underwent deviatomy of the nasal septum and submucosal turbinectomy. The pathological findings suggesting sarcoid granulomatosis indicated a whole body examination. No lesion in the lung, eye and skin was found at that time. Because of her deteriorating nasal lesions such as acute frontal sinusitis and recurrence of the nasal obstruction, she underwent another biopsy about a 18 months after the first surgery. The pathological findings suggested sarcoid granulomatosis and a second whole body examination was performed. The presence of skin, eye and chest lesions in the examinations lead to the final diagnosis of sarcoidosis originating from the nasal cavity. Treatment with local steroids decreased her symptoms. A close follow-up was planned due to the chronic and progressive course of the lesions of her nasal cavity.

Revisiting of Preoperative Blood Ordering Policy—A Single Institute's Experience in Taiwan

If unnecessary blood orders can be reasonably waived, it will reduce both workload and financial expenditure. A review of the surgical blood ordering practice is, therefore, mandatory. Routine preoperative blood orders were retrospectively audited. After receiving the requests, we usually performed only type and screen tests without cross matching until an actual need for transfusion occurred. Transfusion probability (number of patients transfused / number of procedures x 100) was calculated. One unit of donation was defined as 500 mL whole blood. If surgical procedures were associated with insignificant blood loss (number of units transfused < or = 1) and transfusion probability was less than 5%, then it was considered to be safe to disregard a preoperative blood order. The blood ordering practices for 5,472 patients who received various surgical procedures were reviewed over a period of 48 operation days. Neither preoperative requests for preparation of red cells nor transfusion was made in 3,482 patients. Preoperative requests for preparation of red cells were made in 1,990 patients, but only 751 (37.74%) actually received blood transfusion on the day of the operation. Analysis showed that it would have been safe to disregard a preoperative blood order for ophthalmic surgery, ear surgery, nose surgery (endoscopic sinus surgery, submucosal turbinectomy), microlaryngoscopic surgery, tracheostomy, thyroidectomy, mastectomy, laparoscopic cholecystectomy, hemicolectomy, hernioplasty, arthroscopic surgery, laminectomy, laparoscopically assisted vaginal hysterectomy, vasectomy and varicose vein surgery. A review of preoperative blood orders has identified certain surgical procedures with insignificant blood loss and low transfusion probability, for which preoperative blood orders may be safely disregarded in order to reduce unnecessary laboratory workload while not jeopardizing patient safety.

Tratamiento quirúrgico de la hipertrofia de cornetes inferiores con plasma de argón: estudio a largo plazo con 157 pacientes

Surgical treatment of the inferior turbinate in patients with chronic hypertrophic rhinitis that does not respond to medical treatment is a well established procedure. CO2 laser, YAG laser, KTP laser, conventional electrocautery, cryotherapy, chemosurgery and turbinectomy or submucosal turbinectomy have been performed for the removal of nasal obstruction. Argon Plasma Coagulation (APC) is a new, innovative technique in Otorhinolaryngology which is based on high-frequency electrocoagulation with an argon-gas source. The shorter surgical times, the absence of hemorrhagic complications and, in rhinosurgery, not requiring any kind of nasal packing are remarkable. Between March and November 2000, a group of 157 patients with symptoms of nasal obstruction due to hypertrophic inferior turbinates were treated using APC, at the Otorhinolaryngology Surgical Department of the Hospital of Dolo (Venice). The follow-up period was 24 months. Rhinomanometry was performed to objectively measure the nasal obstruction and to verify the postoperative improvement. The Student t-test was used for statistical data. After 24 months, 87% (p<0.001) of patients reported to have a better nasal airflow than before the operation. None of the patients needed a nasal packing after APC surgery. We review and discus the indication, advantages, complications, controversies and long-term results of the treatment with APC in rhinosurgery

Effect of submucosal diathermy in chronic nasal obstruction due to turbinate enlargement

Nasal obstruction is one of the most common chronic presenting symptoms encountered by otolaryngologists. In most patients, the cause of nasal obstruction is either nasal septal deviation or turbinate hypertrophy owing to vasomotor or perennial allergic rhinitis. Most cases of hypertrophic turbinate are usually mild and respond to antihistamine therapy, local decongestions, or allergy desensitization; however, surgery is required in some cases. Surgical treatment is controversial, and many surgical methods of treatment have been proposed. We have recently evaluated the results of our experience with submucosal diathermy (SMD) on 51 patients suffering from chronic nasal obstruction. We have found that diathermy demonstrated good results in 78% of the cases at 2 weeks postoperatively and in 76% of the cases 2 months following the procedure. Patients who had no complaints and had good nasal airflow were not followed-up after 2 months. In the present study, we have carried out a long-term follow-up of another group of patients who had undergone SMD diathermy because of hypertrophy of the inferior turbinates. Patients were examined at 2 months postoperatively and after 1 year, with both subjective and objective assessments of nasal breathing. Two months postoperatively 64 of 91 patients (70.3%) experienced subjective improvement in nasal breathing, where as 73 patients (80.2%) had good nasal breathing as indicated with the Gertner-Podoshin plate. During the follow-up year, secondary operations were deemed necessary for 16 patients because of unsatisfactory results of the original procedure. Of these secondary procedures 4 were revision SMD, 9 patients underwent a septoplasty, in 2 patients functional endoscopic sinus surgery was conducted, and 1 patient had a submucosal turbinectomy. This group of patients was excluded from the 1 year follow-up evaluation. At the 1-year follow-up visit, 65 patients (of the 75) were symptom-free with respect to nasal breathing (86.7%), and 67 patients (89.3%) had good nasal breathing as examined with the Gertner-Podoshin plate. No means were apparent for predicting preoperatively which patients would benefit most from submucosal diathermy. Submucosal diathermy is carried out under local anesthesia and can be implemented as an office procedure. It does not require expensive instrumentation and is a safe, effective procedure for improving nasal breathing in patients with chronic obstructive inferior turbinates, both on a short-term and long-term basis. (Am J Otolaryngol 2002;23:332-336. Copyright 2002, Elsevier Science (USA). All rights reserved.)

粘膜下下甲介骨・後上鼻神経切除術

Submucosal turbinectomy with posterior-superior nasal neurectomy has been performed for 20 patients with intractable allergic rhinitis in our institution. The operations were carried out under endonasal endoscopic observation. After the apical mucous membrane of the inferior turbinate was slightly incised and its bone was resected in the submucosa, both the posterior superior nerve and sphenopalatine artery were cut in the sphenopalatine foramen as one mass using a Harmonic scalpel. In the short-term subjective symptoms observed for 2 to 10 months, sneezing, nasal discharge, and nasal obstruction were improved to 90%, 75%, and 100%, respectively. Additionally, no surgical complications such as massive intraoperative hemorrhage, disturbance of lacrimal secretion or facial numbness were observed. Because this operation method was highly effective, was minimally invasive, and very few complications were observed, it is suggested that this is a novel surgical method for allergic rhinitis or vasomotor rhinitis.

Modified Method of Submucosal Turbinectomy: Mucosal Flap Method

Sixteen patients with nasal obstructions were treated by use of a new technique of submucosal turbinectomy (mucosal flap method) which can reduce a large volume of the turbinate without leaving any mucosal defect. Subjective nasal obstruction showed improvement in all of the cases at 1 month after operation, and objective nasal obstruction examined with rhinomanometry was improved in 13 out of 16 sides of the noses (8 cases). Mucosal flaps were made from the turbinate mucosa facing the common meatus. After excision of the turbinate bone with the mucosa, the bone stump and mucosal defect were covered with the newly repositioned mucosal flap. It is considered that this mucosal flap method can reduce a large volume of the turbinate without leaving any mucosal defect.

粘膜下下甲介切除術変法

粘膜下下甲介切除術変法