Turbinoplasty

What is a Turbinoplasty?

The turbinates are the bony structures on either side of the nose. The turbinates are covered with soft erectile tissue called “nasal mucosa”. These turbinates warm, humidify and purify the air that we breathe. They can swell in response to allergies or sinus infections. When they get large enough to block your breathing this is called “turbinate hypertrophy“. If medication and environmental precautions do not reduce the turbinate size and allow you to breathe well through your nose, you may need a turbinoplasty. Anything that reduces the size of the turbinates to help you breathe better is termed a “turbinoplasty.”

Which Turbinates does Turbinoplasty treat?

There are four types of turbinates inside the nose. From the bottom of the nose to the top are the inferior, middle, superior and supreme turbinates. The largest is the inferior turbinate that extends along the floor from the front to the back of the nose. Turbinoplasty is only used to reduce the size of the inferior turbinates. The middle turbinate can be reduced as well but this is called a “concha bullosa resection.”

How does a Turbinoplasty treat Turbinate Hypertrophy?

There are many effective techniques to reduce hypertrophied turbinates. Some methods shrink or remove the nasal mucosa surrounding the bone of the turbinate, some remove the turbinate bone, and some remove both turbinate bone and soft tissue. The technique used will depend on how big your turbinates are and if they are obstructive due to the bone or due to the soft tissue.

What are the Methods of Turbinoplasty?

The following is a list of techniques used to reduce hypertrophied turbinates that range from simple crushing the bone of the turbinate laterally, to completely remove the turbinate.

1. Turbinate outfracture: The turbinate is crushed laterally away from the nasal septum from the area near the nostril to further back in the nose. This is done with a round metal instrument (Goldman bar) and compresses the bone while doing little to the soft tissue.
2. Coblation turbinate reduction: The soft tissue of the turbinate is “cooked” at low temperatures to shrink the turbinate size. As the turbinate heals the scarring will contract the outer layer of the turbinate and help open the airway. Coblation is a contraction for “controlled ablation.”
3. Laser turbinoplasty: In this method, an optical fiber is used to deliver high-temperature light to the surface of the turbinate. Grooves are cut into the turbinate surface which shrinks the soft tissue of the turbinate. Over time the surface scars and shrinks further before the normal soft tissue mucosa regrows over the turbinate in a few weeks.
4. Cautery turbinate reduction: An electrical current is run through the turbinate with the patient grounded to a grounding pad. The high heat produced will “cook” the soft tissue and shrink it. This can be used in any form of turbinate reduction to control bleeding.
5. Submucosal turbinate reduction: Possible the most effective technique for large turbinates. In this technique, a cut is made in the front of the turbinate and the anterior turbinate bone dissected out and removed. The mucosa is then draped over the area where the bone was removed decreasing the bulk of the turbinate. Often times the excess soft tissue is also removed anteriorly and inferiorly and the remaining soft tissue wrapped around the area of reduction.
6. Partial turbinoplasty: This is only rarely used by surgeons training today. In this technique, the entire front of the inferior turbinate is cut off with scissors. Bleeding can be profuse and is controlled with cautery as described above. This has a much higher risk of “empty nose syndrome” which is when the inside of the nose is “too open” but paradoxically you feel like you can’t breathe through your nose.
7. Total turbinoplasty: The scissors are used to completely remove the entire turbinate. This technique is virtually guaranteed to cause “empty nose syndrome” and should not be used for the improvement of breathing.

 

How does Turbinoplasty address Bilateral Turbinate Hypertrophy?

Since both the left and the right side of the nose have turbinates, and these turbinates are exposed to the same allergies and sinus infections, they both are frequently enlarged. They can be reduced on either side of the septum. The same, multiple or different techniques can be used to reduce the bilateral turbinates.

May I have Septoplasty with Turbinoplasty?

Septoplasty is straightening of the deviated nasal septum, the wall that divides the left and right sides of the nose. Making the nasal septum less deviated may bring the septum closer to one or both of the turbinates. If you have a deviated septum and turbinate hypertrophy you would want both of these procedures performed at the same time whenever possible.

Can you tell me about my Turbinoplasty surgery?

The procedure can be performed in the office, in an ambulatory surgery center, or in the hospital. Local or general anesthesia may be used meaning you may be able to choose to be awake or asleep during the surgery. The procedure can be combined with other procedures such as septoplasty, sinus surgery, or repair of a nasal fracture. You generally go home about an hour after the turbinoplasty.

How is the recovery from Turbinoplasty?

You will tend to be stuffy for a few days to a week although some people breathe better right away. The turbinates tend to swell and you can have some yellow or bloody crusts for a few weeks. The turbinates are mildly uncomfortable but rarely painful. The worst part of recovery is the congestion that sometimes feels like a bad cold. Depending on the technique used, you may want to limit your exertion for a couple of weeks to decrease the chances of bleeding. Saline rinses will help to heal by washing away some of the crusting. With the correct turbinoplasty and proper postoperative care, you should be breathing better than before your procedure in just a few short weeks!