Dr. Vinay. S. Bhat
Otolaryngology (E.N.T)
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
If an unwanted out fracture of the inferior turbinates is performed, would it be possible for the underlying bone (inferior nasal concha) to heal back into one piece if it is set and splinted into its original position? Also, how long after an out fracture would one have to have this reset and splint before it is too late? Thanks in advance.
Hello,
Welcome to icliniq.com.
Out fracture of the inferior turbinate is a surgical procedure sometimes done for hypertrophy of inferior turbinate causing nasal obstruction. Mostly it is done along with some septal surgery such as septoplasty and is rarely done as a standalone procedure. Inferior turbinate bone is a thin bone that gets fractured easily when intentionally done to reduce the size of the turbinate. It does not need any splinting as it heals within a couple of weeks in its fractured position. The outcome of the out fracture of the inferior turbinate is just a moderate increase in breathing space. For this reason, this procedure is done for mild to moderate enlargement of the inferior turbinate. This procedure is very safe and does not have any significant complications.
Patient's Query
Hello doctor,
Thank you for the reply. I have been told that the bone remains in two pieces (non-union) and does not reheal in its fractured position unless set and splinted (as the weight of the surrounding tissue and mucosa is pulling down on the bottom piece and preventing the union). Can you point me to a citation that mentions this? I did not want my turbinate out fractured; the airway was already too open, dry, crusty, etc. However, if it is set and splinted to heal back into two pieces, would the bone heal back in its original position and return the turbinate back to its original position?
Hello,
Welcome back to icliniq.com.
Since turbinate bone is a thin bone, once out fractured, it does not unite, and if at all it unites because of incomplete out fracture, it will not regain its original position. This answers your second question too. Splinting of inferior turbinate bone, unlike any other bone in the body, may not serve any purpose as turbinate will not go back to its normal position permanently in most of the instances, and splinting of inferior turbinate bone is not described in the literature convincingly. In general, out fracture of inferior turbinate bone will not cause a significant increase in the airway, and it is unlikely to be the reason for your crusting and dryness. Mucosa over the bone compensates eventually. That is why out fracture is never considered a permanent treatment for inferior turbinate hypertrophy.
Patient's Query
Hello doctor,
Thank you for the reply. I am a bit confused (hearing conflicting information). I understand that it will not regain its original position after being out fractured if left alone as the weight of the surrounding tissue or mucosa is holding the two pieces apart. But, in theory, if it were splinted or packed into a position to allow the fractured bone pieces to heal back into one, would this be possible? (let us say, within a week of its initial out fracturing). The reason I ask is my otolaryngologist is mentioning this as an option, and I can not find anything online about it.
Hello,
Welcome back to icliniq.com.
You can not find anything online as it is not a standard procedure that is practiced. It is just a trial that your surgeon can attempt, but its success can not be assured. In theory, it can work if both the pieces join, but there is no evidence that it will make any difference in the nose physiology. As I mentioned earlier, the inferior turbinate bone does not contribute much to nasal physiology. It is the overlying mucosa that is more important. Within a couple of months, mucosa will increase in size and compensate for the out fracture-induced additional space.
Patient's Query
Hi doctor,
Thank you for the reply.
Hi,
Welcome back to icliniq.com.
We do out fracture commonly in compensatory hypertrophy of inferior turbinate secondary to the deviated nasal septum. The intention here is to improve the airway temporarily before nasal physiology starts working again after bringing the septum back to midline. Out fracture is never intended to be a permanent turbinate reduction procedure as mucosa tends to regrow over time.
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Otolaryngology (E.N.T)
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