Turbinate Reduction Surgery - Risks, Indications, and Precautions

Introduction:

Turbinates are the small structures inside the nose that helps in cleaning and humidifying the air inhaled through the nostrils into the lungs. They are composed of bony structures surrounded by vascular tissues, and the outer layer is composed of a mucous membrane. These turbinates may get swollen or inflamed due to infection or allergies and may cause nasal obstruction, and can also produce excessive amounts of mucous, causing congestion in the nasal cavity and leading to congestion. Therefore turbinate reduction surgery is done to correct the airflow.

What Are Turbinates, and What Do They Do?

Turbinates are the important structures present in the nasal airway. Their primary function is to warm, humidify and filter the air breathed in. Three types of turbinates are present on each side of the nasal cavity, which include superior, middle, and inferior. The turbinates swell and shrink on their own to regulate the airflow. However, in case of allergies, infection, or irritation, the turbinates increase in size permanently. This can lead to nasal obstruction, snoring, or obstructive sleep apnea or OSA (a condition in which the upper airway gets blocked while sleeping).

The inferior turbinate runs along the length of the nasal cavity, is the largest among the three and is more prone to swelling and blocking airflow. The middle turbinates are located slightly higher in the nasal cavity and near the opening of several sinuses. The middle turbinates can lead to the narrowing of the sinuses in some cases due to their abnormal shape or swelling. This can lead to pain because of the high pressure created in the nasal cavity. Concha bullosa is one of the most common conditions of the middle turbinates caused by the development of air bubbles in the middle turbinate leading to nasal obstruction.

What Is Turbinate Reduction?

Turbinate reduction is a surgical procedure to improve airflow in people with chronic nasal congestion. This is also known as nasal turbinate reduction, inferior turbinate reduction, and bilateral turbinate reduction when the surgery is performed on both sides of the nose. This procedure helps decrease the size of turbinates and is a same-day procedure performed under local anesthesia. This procedure is recommended in cases where turbinates are chronically enlarged and block other portions of the nasal airway.

Why Is Turbinate Reduction Surgery Done?

The turbinate reduction surgery is done in people facing breathing issues due to hypertrophy (enlargement) of tissues in the nasal cavity. Some of the common causes of turbinate enlargement include -

• Allergies.

• Infection or irritation.

• Stress.

• Weather changes.

• Hormonal changes.

• Medications.

In addition to that, this surgery is also indicated in conditions such as -

• Nasal congestion and rhinorrhea (runny nose) with hypertrophy of inferior turbinate.

• Sleep apnea.

• Rhinitis (swelling and irritation of the mucous membrane of the nose).

• Patients undergoing recurrent procedures such as septoplasty or rhinoplasty because of hypertrophy of the inferior turbinate.

• Chronic infections.

• Severe allergic reactions.

Turbinate surgery is often recommended after septoplasty, correcting a deviated septum.

What Are the Contraindications of Turbinate Reduction Surgery?

Some of the factors that may impact the overall results of turbinate reduction surgery include -

• Severe nasal or septal deformity.

• Internal or external valve collapse.

• Acute allergic or infectious rhinitis.

• Active respiratory infection.

How Is Turbinate Surgery Performed?

Turbinate surgery is a same-day procedure performed under general anesthesia in a hospital. However, in some cases, it can also be performed under local anesthesia. This procedure can be done using one of the following techniques which include -

1. Cauterization - In this technique, a heated probe is placed inside the nose to close off some of the blood vessels of the turbinates. This reduces blood flow in the turbinates, causing them to shrink and clear the airway.

2. Radiofrequency Turbinate Reduction - In this technique, high-frequency electrical currents are delivered to the inflamed turbinates using a long and thin probe. This leads to formation of scar tissue causing the shrinkage of turbinates.

3. Coblation - The term coblation means controlled ablation. This technique is the same as radiofrequency reduction, but in this technique, heat energy is used instead of electrical energy to shrink the turbinate tissues. This is a less invasive method as it keeps the surrounding tissues intact.

4. Microdebrider Submucosal Resection - In this method, a small hole or opening is created in the turbinate, the tissue is removed from that opening, and the outer lining of the turbinate is left untouched. This causes the turbinate to shrink.

5. Partial Resection - In this procedure, a small piece of turbinate is removed compared to other techniques, and both soft and hard tissues are removed.

What Are the After-Surgery Precautions?

• After surgery patient is advised to avoid blood-thinning medicines such as Aspirin.

• There may be mild discomfort or pain after the procedure, which can be treated by taking painkillers prescribed by the doctor.

• Patients are advised to avoid strenuous physical activity for atleast two weeks.

• To stimulate healing, nasal saline sprays can wash loose debris, such as dried blood.

• A nasal decongestant can be used to decrease the amount of swelling in the nose and keep the nasal passage open. It also helps in controlling unwanted bleeding.

What Are the Advantages and Disadvantages of Turbinate Reduction Surgery?

The advantages of turbinate reduction surgery include the following -

• It helps in opening the nasal airway, therefore, helps in breathing.

• Reduce snoring.

• Helpful in treating severe allergies.

Disadvantages of turbinate reduction surgery include -

• This procedure may result in empty nose syndrome (a rare condition in which a patient cannot feel the air passing through the nose).

• Nosebleeds.

• Dryness.

What Are the Risks Involved in This Procedure?

Some of the risks involved with this procedure include the following -

• The patient may feel mild to moderate pain during the procedure, which can be controlled by administering extra anesthesia.

• Mild to moderate edema may be present, causing nasal obstruction.

• A thick mucous formation may also occur in the first week after the procedure.

• Mucosal erosion can also occur, leading to postoperative bleeding and increasing the chances of crusting in the nose.

• Loss of sensation in the skin of the nose.

• Change in the sense of smell.

• Fluid build-up in the nose.

Conclusion:

Nasal congestion or obstruction can severely impact breathing and quality of life. Therefore turbinate reduction surgery can be beneficial in treating this condition. Like every other procedure, it does have some pros and cons. Therefore, patients should discuss every outlook with their healthcare professional before surgery.