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• W2165094668 abstract "The inferior turbinate is an important structure serving a vital role in nasal physiology. However, inferior turbinate enlargement can lead to decreased nasal airflow and a sensation of nasal obstruction. Chronic nasal obstruction can substantially affect quality of life, productivity, and finances, and when medical therapies fail, surgical management is often recommended. Many techniques for inferior turbinate reduction exist, including outfracturing, submucosal soft tissue reduction (ie, electrocautery, radiofrequency coblation, and powered microdebrider), submucosal bone removal, argon plasma coagulation, laser reduction, partial turbinectomy, and total turbinectomy. These techniques have demonstrated varied long-term results, and there remains a lack of consensus as to the optimal surgical technique. However, given the important role the inferior turbinates play in nasal physiology, many contemporary surgeons aim to strike a balance between adequate tissue resection for symptom improvement and preservation of functional turbinate tissue and its contribution to normal nasal physiology. The inferior turbinate is an important structure serving a vital role in nasal physiology. However, inferior turbinate enlargement can lead to decreased nasal airflow and a sensation of nasal obstruction. Chronic nasal obstruction can substantially affect quality of life, productivity, and finances, and when medical therapies fail, surgical management is often recommended. Many techniques for inferior turbinate reduction exist, including outfracturing, submucosal soft tissue reduction (ie, electrocautery, radiofrequency coblation, and powered microdebrider), submucosal bone removal, argon plasma coagulation, laser reduction, partial turbinectomy, and total turbinectomy. These techniques have demonstrated varied long-term results, and there remains a lack of consensus as to the optimal surgical technique. However, given the important role the inferior turbinates play in nasal physiology, many contemporary surgeons aim to strike a balance between adequate tissue resection for symptom improvement and preservation of functional turbinate tissue and its contribution to normal nasal physiology. The inferior turbinate is an important structure, serving a vital role in nasal physiology. It has many functions, including the filtration, warming, and humidification of inspired air, in addition to the regulation of nasal airflow. However, inferior turbinate enlargement, due to hypertrophy or edema, can lead to decreased nasal airflow, and subsequently, a sensation of nasal obstruction. Chronic nasal obstruction can substantially affect quality of life, productivity, and finances.1Scheithauer M.O. Surgery of the turbinates and “empty nose” syndrome.GMS Curr Top Otorhinolaryngol Head Neck Surg. 2010; 9 ([Doc03])PubMed Google Scholar, 2Juniper E.F. Impact of upper respiratory allergic diseases on quality of life.J Allergy Clin Immunol. 1998; 101: S386-S391Abstract Full Text Full Text PDF PubMed Scopus (72) Google Scholar A number of medical therapies exist to treat patients with nasal obstruction secondary to enlarged inferior turbinates; however, when these medical therapies fail, surgical management is often recommended. The focus of this article is a wide variety of surgical techniques that have been described to reduce the size of enlarged inferior turbinates when medical management has yielded unsatisfactory results. Inferior turbinate reduction is one of the most commonly performed sinonasal surgical procedure, and the most common indication for turbinate reduction is nasal obstruction due to inferior turbinate enlargement. In addition to relief of nasal obstruction, inferior turbinate reduction may also play a role in the treatment of adult and pediatric sleep-disordered breathing.3Cheng P.W. Fang K.M. Su H.W. et al.Improved objective outcomes and quality of life after adenotonsillectomy with inferior turbinate reduction in pediatric obstructive sleep apnea with inferior turbinate hypertrophy.Laryngoscope. 2012; 122: 2850-2854Crossref PubMed Scopus (39) Google Scholar, 4Powell N.B. Zonato A.I. Weaver E.M. et al.Radiofrequency treatment of turbinate hypertrophy in subjects using continuous positive airway pressure: A randomized, double-blind, placebo-controlled clinical pilot trial.Laryngoscope. 2001; 111: 1783-1790Crossref PubMed Scopus (126) Google Scholar There are numerous possible etiologies for inferior turbinate enlargement. This includes physiological, anatomical, or pathophysiological causes, such as allergic, vasomotor, and hormonal rhinitis, as well as systemic inflammatory diseases. As such, an assessment for allergic and other systemic etiologies is a crucial component of a comprehensive medical history of any patient being evaluated for nasal obstruction. Physical examination should include anterior rhinoscopy and nasal endoscopy, before and after nasal decongestion, to differentiate between possible bony and soft tissue contributions to turbinate enlargement and the patient׳s symptoms. Before considering surgical intervention, treatment typically consists of medical therapy, which may include topical nasal steroids, antihistamines, and nasal saline irrigations.5Goyal P.M. Hwang P.H. Surgery of the septum and turbinates.in: Kennedy D.W. Hwang P.H. Rhinology: Diseases of the Nose, Sinuses, and Skull Base. Thieme, New York, NY2012: 444-456Google Scholar The inferior turbinate is composed of a central bony portion that projects from the medial aspect of the maxillary and palatine bones at varying angles, and is surrounded medially, laterally, and inferiorly by a layer of soft tissue. This soft tissue layer, which is thickest along the medial aspect of inferior turbinate, is composed of erectile tissue with seromucinous glands and venous sinusoids and is covered by pseudostratified ciliated columnar epithelium.5Goyal P.M. Hwang P.H. Surgery of the septum and turbinates.in: Kennedy D.W. Hwang P.H. Rhinology: Diseases of the Nose, Sinuses, and Skull Base. Thieme, New York, NY2012: 444-456Google Scholar, 6Berger G. Balum-Azim M. Ophir D. The normal inferior turbinate: Histomorphometric analysis and clinical implications.Laryngoscope. 2003; 113: 1192-1198Crossref PubMed Scopus (52) Google Scholar The venous sinusoids play a significant role in the regulation of mucosal thickness and are controlled by sympathetically innervated arterial resistance vessels. The inferior turbinate has a rich, variable blood supply, mainly provided by the posteriorly located inferior turbinate branch of the posterior lateral nasal artery, originating from the sphenopalatine artery.7Orhan M. Midilli R. Gode S. et al.Blood supply of the inferior turbinate and its clinical applications.Clin Anat. 2010; 23: 770-776Crossref PubMed Scopus (14) Google Scholar The inferior turbinates play an important role in nasal physiology. By increasing the mucosal surface area in the nasal cavity, the turbinates serve to warm and humidify inspired air, and thus facilitate pulmonary alveolar gas exchange. Furthermore, the orientation and shape of the turbinates streamline inspired air posteriorly, while providing sufficient resistance to decrease airflow velocity and change it from a laminar to a transitional pattern.5Goyal P.M. Hwang P.H. Surgery of the septum and turbinates.in: Kennedy D.W. Hwang P.H. Rhinology: Diseases of the Nose, Sinuses, and Skull Base. Thieme, New York, NY2012: 444-456Google Scholar, 8Mirza N. Lanza D.C. The nasal airway and obstructed breathing during sleep.Otolaryngol Clin North Am. 1999; 32: 243-262Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar This increase in turbulence aids in the filtration function of the nasal cavity, by allowing for the trapping of inspired debris in the mucus layer of the nasal epithelium, which then serves to remove the debris from the nasal cavity through mucociliary clearance. When nasal resistance is abnormally low (eg, owing to excessive inferior turbinate surgical reduction), the altered airflow and resistance patterns may lead to paradoxical subjective complaints of nasal obstruction, known as “empty nose syndrome.”5Goyal P.M. Hwang P.H. Surgery of the septum and turbinates.in: Kennedy D.W. Hwang P.H. Rhinology: Diseases of the Nose, Sinuses, and Skull Base. Thieme, New York, NY2012: 444-456Google Scholar, 9Houser S.M. Surgical treatment for empty nose syndrome.Arch Otolaryngol Head Neck Surg. 2007; 133: 858-863Crossref PubMed Scopus (79) Google Scholar Most people experience irregularly alternating asymmetric airflow through the nose, commonly referred to as “the nasal cycle,” due to alternating engorgement within the nasal erectile mucosa, and especially that of the inferior turbinates. At any given time, one side of the nasal passages is typically more congested with a reduced amount of secretions, whereas the contralateral nasal cavity is more widely patent but has increased secretions from serous and mucus glands. Despite the constant fluctuation of each individual turbinate size and ipsilateral airway resistance, the total resistance of the whole nasal airway has been noted to be constant, as described by Kayser in 1895.5Goyal P.M. Hwang P.H. Surgery of the septum and turbinates.in: Kennedy D.W. Hwang P.H. Rhinology: Diseases of the Nose, Sinuses, and Skull Base. Thieme, New York, NY2012: 444-456Google Scholar, 10Eccles R. A role for the nasal cycle in respiratory defence.Eur Respir J. 1996; 9: 371-376Crossref PubMed Scopus (81) Google Scholar Numerous surgical techniques have been described for the treatment of inferior turbinate hypertrophy, and there remains a lack of consensus as to the optimal technique. These surgical techniques differ in the amount and type of tissue resection and preservation (Figure 1). As our understanding of nasal physiology has grown, surgical techniques have also evolved with the aim to achieve both maximal symptom improvement and preservation of function. Furthermore, in the current age of rising health care costs, some of the turbinate procedures described are now performed in the office setting using local and topical analgesia. The following techniques are discussed in a sequential order, starting with techniques that generally involve the least amount of tissue removal and progressing toward techniques with more tissue resection. Lateralization of the inferior turbinate involves an outfracturing of the turbinate bone to decrease the angle with which the inferior turbinate bone projects from the maxillary and palatine bones along the lateral nasal wall (Figures 1A and 2).11Aksoy F. Yildirim Y.S. Veyseller B. et al.Midterm outcomes of outfracture of the inferior turbinate.Otolaryngol Head Neck Surg. 2010; 143: 579-584Crossref PubMed Scopus (27) Google Scholar This procedure typically begins with an infracture of the turbinate bone by placing a Boies or Goldman elevator lateral to the inferior turbinate in the inferior meatus. Force is then directed medially and superiorly in an attempt to avoid a greenstick fracture, but rather create a fracture line near the bony attachment to the lateral nasal wall (Figure 2A and B). This, in turn helps to achieve maximal lateralization when the inferior turbinate is subsequently outfractured by using the elevator to direct force inferiorly and laterally along the turbinate׳s attachment site to the lateral nasal wall (Figure 2C). Lateralization of the inferior turbinate is generally not considered sufficient as a stand-alone procedure for the management of significant turbinate hypertrophy, but it can be helpful when used in conjunction with other turbinate reduction procedures.5Goyal P.M. Hwang P.H. Surgery of the septum and turbinates.in: Kennedy D.W. Hwang P.H. Rhinology: Diseases of the Nose, Sinuses, and Skull Base. Thieme, New York, NY2012: 444-456Google Scholar The submucosal soft tissue of the inferior turbinate can be reduced using a variety of methods, including direct tissue resection, and various thermal techniques that produce submucosal injury (Figures 1B and 3). This leads to submucosal fibrosis and contracture, with obliteration of the venous sinusoids, and a reduction of the erectile properties of the submucosal tissue. Monopolar electrocautery and bipolar electrocautery can be used to produce submucosal thermal injury. This technique involves the use of a single needle electrode (Figure 3A), or bipolar forceps with needle tips. After the administration of local anesthetic, the electrode can be pressed against the head (anterior portion) of the inferior turbinate and activated for a short period to produce a devascularized zone. The needle electrode is then inserted into the submucosa through this zone and advanced toward the tail of the inferior turbinate while taking care to stay close to the turbinate bone. The electrocautery is then activated as the needle is slowly withdrawn to inflict the thermal injury near the tip of the electrode. Preference regarding the power and duration of electrocautery, as well as the optimal number of passes, is surgeon dependent.1Scheithauer M.O. Surgery of the turbinates and “empty nose” syndrome.GMS Curr Top Otorhinolaryngol Head Neck Surg. 2010; 9 ([Doc03])PubMed Google Scholar, 12Elwany S. Gaimaee R. Fattah H.A. Radiofrequency bipolar submucosal diathermy of the inferior turbinates.Am J Rhinol. 1999; 13: 145-149Crossref PubMed Scopus (43) Google Scholar, 13Woodhead C.J. Wickham M.H. Smelt G.J. et al.Some observations on submucous diathermy.J Laryngol Otol. 1989; 103: 1047-1049Crossref PubMed Scopus (30) Google Scholar Radiofrequency tissue reduction involves the direct application of a high-frequency current to the targeted tissue, leading to submucosal injury from friction between ions. This technique differs from the electrocautery technique in several ways; although it still generates enough thermal energy to cause the desired submucosal injury, the maximal temperature generated (typically less than 85°C), and dissipation of the heat within the tissue, is significantly lower than that with electrocautery (which can reach up to 800°C).5Goyal P.M. Hwang P.H. Surgery of the septum and turbinates.in: Kennedy D.W. Hwang P.H. Rhinology: Diseases of the Nose, Sinuses, and Skull Base. Thieme, New York, NY2012: 444-456Google Scholar, 14Cavaliere M. Mottola G. Iemma M. Comparison of the effectiveness and safety of radiofrequency turbinoplasty and traditional surgical technique in treatment of inferior turbinate hypertrophy.Otolaryngol Head Neck Surg. 2005; 133: 972-978Crossref PubMed Scopus (84) Google Scholar This is one of the reasons the technique has become popular in the office setting under local anesthesia. There are numerous radiofrequency devices designed with both monopolar and bipolar delivery of energy. Much like the electrocautery technique, the turbinate is first infiltrated with local anesthetic, which can expand the submucosal tissue making the procedure easier to perform. The wand tip is then coated in saline gel or another conductive media and activated at the head of the turbinate to produce a devascularized zone. The wand is then inserted through this zone and advanced toward the tail of the turbinate submucosally (Figure 3B). It is then activated for a short period (eg, 10 seconds), and then partly withdrawn and activated again. As with submucosal electrocautery, preference regarding the power and duration of coblation, and the optimal number of passes, is surgeon dependent. Typically, settings of 75°C-85°C, 10-15 W, and 300-500 J, or a coblation setting of 4-5, have been reported in the literature depending on the system used. Similar to the submucosal thermal techniques described, the intention of powered submucosal resection is to reduce the amount of submucosal erectile tissue, while leaving the overlying epithelium unharmed. With the recent advent of a smaller (2.0-2.9 mm), specifically designed inferior turbinate microdebrider blade, with an incorporated tip elevator, this procedure has been made easier (Figure 3C). The inferior turbinate is first infiltrated with local anesthetic, typically with epinephrine, to limit hemorrhage and expand the targeted submucosal soft tissue. The tip of the specialized microdebrider blade, or a scalpel, is then used to perform a stab incision in the head of the inferior turbinate (Figure 4A). The microdebrider blade is then advanced (with the cutting surface facing laterally) and used to create a submucosal pocket on the inferomedial surface of the turbinate bone, using the flat tip as an elevator (Figure 4B). If a specialized turbinate blade is not available, the flap dissection can be performed using a Cottle or Freer elevator.5Goyal P.M. Hwang P.H. Surgery of the septum and turbinates.in: Kennedy D.W. Hwang P.H. Rhinology: Diseases of the Nose, Sinuses, and Skull Base. Thieme, New York, NY2012: 444-456Google Scholar The microdebrider blade is then rotated toward the submucosal soft tissue and activated, typically at speeds of up to 3,000 rpm in oscillating mode. Care must be taken to avoid flap perforation, while targeting the anterior and inferomedial submucosal soft tissue that contributes most significantly to nasal airflow obstruction.6Berger G. Balum-Azim M. Ophir D. The normal inferior turbinate: Histomorphometric analysis and clinical implications.Laryngoscope. 2003; 113: 1192-1198Crossref PubMed Scopus (52) Google Scholar Submucosal resection can be carried all the way to the tail of the turbinate posteriorly; however, this does carry an increased risk of bleeding owing to injury to vascular contributions from the posterior lateral nasal and sphenopalatine arteries. Submucosal resection of the inferior turbinate bone is another technique that can be especially effective in patients with enlarged turbinate bone, which can be a major contributor to turbinate enlargement (Figures 1C and 5). Depending on the thickness of the inferior turbinate bone, it may be possible to resect a portion of it using the submucosal powered microdebrider technique previously described, with the blade turned laterally against the turbinate bone. Alternatively, a more comprehensive resection of the bone can be performed using a more traditional submucosal dissection. For this technique, a larger anterior incision is made and extended posteriorly along the inferior edge of the turbinate (Figure 5A). A Cottle or Freer elevator is then used to raise a mucoperiosteal flap medially off the underlying turbinate bone (Figure 5B). Another mucoperiosteal flap can then be raised off the lateral surface of the turbinate bone, and the 2 flaps can be apposed after the bone is resected with a through-cutting instrument (Figure 5C and D). Alternatively, as described by Mabry,15Mabry R.L. “How I do it”—Plastic surgery. Practical suggestions on facial plastic surgery. Inferior turbinoplasty.Laryngoscope. 1982; 92: 459-461Crossref PubMed Scopus (33) Google Scholar the lateral turbinate mucosa can be resected along with the turbinate bone, and the remaining flap of medial and inferior mucosal tissue can be rolled up on itself, from medial to lateral, to form a neoturbinate with 2 apposing inverted raw surfaces, and an external mucosal surface (Figure 1D).16Bielamowicz S. Hawrych A. Gupta A. Endoscopic inferior turbinate reduction: A new technique.Laryngoscope. 1999; 109: 1007-1009Crossref PubMed Scopus (15) Google Scholar Using a novel approach, Greywoode et al17Greywoode J.D. Van Abel K. Pribitkin E.A. Ultrasonic bone aspirator turbinoplasty: A novel approach for management of inferior turbinate hypertrophy.Laryngoscope. 2010; 120: S239Crossref PubMed Scopus (16) Google Scholar recently described the use of an ultrasonic bone aspirator to remove inferior turbinate bone. This device uses ultrasonic waves to emulsify bone, with concurrent irrigation and microsuction of bone particles producing a clean surgical field; this reportedly enables removal of the inferior turbinate bone without thermal or mechanical injury to the surrounding soft tissue or mucosa. Numerous mucosal sacrificing techniques have been reported describing different degrees of inferior turbinate resection. However, prevailing knowledge of the important role that the inferior turbinate and its epithelium play in nasal physiology has led many surgeons to steer away from more aggressive full-thickness resection techniques and those involving extensive resection of the turbinate epithelium. Anterior turbinectomy removes a small portion (1.5-2.0 cm) of full-thickness tissue at the head of the inferior turbinate in the region of the internal nasal valve. Limiting partial turbinate resection to this portion of the inferior turbinate allows the surgeon to address the region of greatest nasal airway resistance, while lowering the risk of hemorrhage secondary to injury to the posterior vascular supply.7Orhan M. Midilli R. Gode S. et al.Blood supply of the inferior turbinate and its clinical applications.Clin Anat. 2010; 23: 770-776Crossref PubMed Scopus (14) Google Scholar, 18Fanous N. Anterior turbinectomy. A new surgical approach to turbinate hypertrophy: A review of 220 cases.Arch Otolaryngol Head Neck Surg. 1986; 112: 850-852Crossref PubMed Scopus (56) Google Scholar, 19Willatt D. The evidence for reducing inferior turbinates.Rhinology. 2009; 47: 227-236PubMed Google Scholar Further, tissue is sometimes resected from the “scroll” region of the turbinate, inferior to the bone. The tissue to be resected can first be clamped for a short period and injected with anesthetic with epinephrine to decrease the risk of bleeding. The resection can then be performed with a through-cutting instrument or a microdebrider. Argon plasma coagulation allows for contact-free thermocoagulation of tissue by using a current that is conducted through ionized argon gas, which forms an arc of current between the handpiece and the tissue. The energy delivered to the tissue with this technique is limited to 1-2 mm of penetration.1Scheithauer M.O. Surgery of the turbinates and “empty nose” syndrome.GMS Curr Top Otorhinolaryngol Head Neck Surg. 2010; 9 ([Doc03])PubMed Google Scholar It was first applied in the field of otolaryngology for the treatment of juvenile laryngeal papillomatosis and epistaxis secondary to hereditary hemorrhagic telangiectasias.20Bergler W.F. Sadick H. Hammerschmitt N. et al.Long-term results of inferior turbinate reduction with argon plasma coagulation.Laryngoscope. 2001; 111: 1593-1598Crossref PubMed Scopus (37) Google Scholar When used for the treatment of inferior turbinate hypertrophy, the handpiece applicator is used to pass the argon plasma coagulation beam slowly over the entire length of the lower one-third to one-half of the inferior turbinate in 3-4 parallel lines (Figure 6). Direct contact of the applicator tip with the turbinate tissue is avoided because it prevents the desired effects.20Bergler W.F. Sadick H. Hammerschmitt N. et al.Long-term results of inferior turbinate reduction with argon plasma coagulation.Laryngoscope. 2001; 111: 1593-1598Crossref PubMed Scopus (37) Google Scholar Lasers produce a precise beam of coherent light that may be accurately delivered, producing minimal damage beyond the area requiring treatment. Tissue absorption of the energy is dependent on the wavelength of the laser light, which can be delivered in either a pulsed mode or a continuous mode. The use of a laser for inferior turbinate reduction has been around since the late 1970s and is particularly useful when soft tissue hypertrophy predominates.21Lenz H. Eichler J. Knof J. et al.Endonasal Ar+-laser beam guide system and first clinical application in vasomotor rhinitis (author׳s transl).Laryngol Rhinol Otol. 1977; 56: 749-755PubMed Google Scholar, 22Lenz H. Eichler J. Schafer G. et al.Parameters for argon laser surgery of the lower human turbinates. In vitro experiments.Acta Otolaryngol. 1977; 83: 360-365Crossref PubMed Scopus (26) Google Scholar A number of lasers have been used for this technique, including the argon laser, the carbon dioxide (CO2) laser, the diode laser, the holmium: yttrium aluminum garnet laser, the potassium titanyl phosphate (KTP) laser, and the neodymium: yttrium aluminum garnet (Nd:YAG) laser. Given the considerable differences in the various laser beam properties, such as the degree of hemostasis, tissue ablation, and depth of penetration, the laser systems can be used in a variety of methods to achieve turbinate reduction. This ranges from simple tissue ablation, to laser mucotomy (excision of superficial mucosa), to partial or total turbinectomy with the laser used as a cutting instrument (Figure 1E). Degloving of the inferior turbinate is a technique whereby the soft tissue and epithelium overlying the turbinate bone is resected along the whole length of the turbinate.23Chevretton E.B. Hopkins C. Black I.M. et al.Degloving of the inferior turbinates: Pilot study to assess the effectiveness of a new technique in turbinate reduction.J Laryngol Otol. 2003; 117: 866-870Crossref PubMed Scopus (7) Google Scholar Despite results that suggest sustained improvement in nasal obstruction up to 2 years after surgery, this technique is not commonly used owing to fear of tissue overresection, destruction of the important pseudostratified ciliated columnar epithelium, and the possible deleterious effects on normal nasal physiology. Total or “radical” turbinectomy involves the complete resection of the inferior turbinate using heavy scissors to detach it directly at its site of attachment to the lateral nasal wall (Figure 1F). This technique can reduce the nasal resistance up to 50%.24Wight R.G. Jones A.S. Beckingham E. Radical trimming of the inferior turbinates and its effect on nasal resistance to airflow.J Laryngol Otol. 1988; 102: 694-696Crossref PubMed Scopus (18) Google Scholar It was commonly used in first half of the twentieth century but eventually fell out of favor with many surgeons owing to concerns for severe long-term complications such as atrophic rhinitis and ozaena.1Scheithauer M.O. Surgery of the turbinates and “empty nose” syndrome.GMS Curr Top Otorhinolaryngol Head Neck Surg. 2010; 9 ([Doc03])PubMed Google Scholar These complications likely develop secondary to the loss of the inferior turbinate׳s contribution to nasal physiology and are associated with excessive mucosal drying, scarring, foul smelling nasal discharge, and recurrent epistaxis.25Moore E.J. Kern E.B. Atrophic rhinitis: A review of 242 cases.Am J Rhinol. 2001; 15: 355-361PubMed Google Scholar Furthermore, this technique has been associated with a higher risk of hemorrhage and pain in the immediate postoperative period.26Goode R.L. Surgery of the turbinates.J Otolaryngol. 1978; 7: 262-268PubMed Google Scholar, 27Persky M.A. Possible hemorrhage after inferior turbinectomy.Plast Reconstr Surg. 1993; 92: 770Crossref PubMed Scopus (3) Google Scholar, 28Garth R.J. Cox H.J. Thomas M.R. Haemorrhage as a complication of inferior turbinectomy: A comparison of anterior and radical trimming.Clin Otolaryngol Allied Sci. 1995; 20: 236-238Crossref PubMed Scopus (33) Google Scholar However, despite these factors, some surgeons still support this technique as a safe and effective method for treating nasal obstruction.29Talmon Y. Samet A. Gilbey P. Total inferior turbinectomy: Operative results and technique.Ann Otol Rhinol Laryngol. 2000; 109: 1117-1119Crossref PubMed Scopus (24) Google Scholar The complications of inferior turbinate reduction include postoperative hemorrhage, short- and long-term nasal dryness and crusting, scarring, atrophic rhinitis, ozaena, and “empty nose syndrome.” The reported rates of each of these complications vary from one technique to another.5Goyal P.M. Hwang P.H. Surgery of the septum and turbinates.in: Kennedy D.W. Hwang P.H. Rhinology: Diseases of the Nose, Sinuses, and Skull Base. Thieme, New York, NY2012: 444-456Google Scholar As previously mentioned, many of these complications may be attributed to aggressive tissue resection and alteration of normal nasal physiology. Many authors have observed that patients who have a total resection of the inferior turbinates can have a paradoxical sensation of nasal congestion, a condition commonly referred to as “empty nose syndrome.” The etiology of this condition is unknown but may be related to the loss or alteration of the normal sensation of breathing through the nose, including the loss of sensory input from the turbinates themselves.25Moore E.J. Kern E.B. Atrophic rhinitis: A review of 242 cases.Am J Rhinol. 2001; 15: 355-361PubMed Google Scholar Given the important role the inferior turbinates play in nasal physiology, many contemporary surgeons aim to strike a balance between adequate tissue resection and preservation of as much functional turbinate tissue as possible. This objective has led some researchers to examine the effect that different techniques in inferior turbinate reduction have on mucociliary clearance, as well as the histopathologic features of the turbinate. To date, results have been mixed with a general trend toward better results with radiofrequency and partial resection techniques and worse effects with electrocautery and laser techniques.30Berger G. Ophir D. Pitaro K. et al.Histopathological changes after coblation inferior turbinate reduction.Arch Otolaryngol Head Neck Surg. 2008; 134: 819-823Crossref PubMed Scopus (28) Google Scholar, 31Sargon M.F. Celik H.H. Uslu S.S. et al.Histopathological examination of the effects of radiofrequency treatment on mucosa in patients with inferior nasal concha hypertrophy.Eur Arch Otorhinolaryngol. 2009; 266: 231-235Crossref PubMed Scopus (10) Google Scholar, 32Olszewska E. Sieskiewicz A. Kasacka I. et al.Cytology of nasal mucosa, olfactometry and rhinomanometry in patients after" @default.
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• W2165094668 date "2014-06-01" @default.
• W2165094668 modified "2023-10-12" @default.
• W2165094668 title "Inferior turbinate reduction" @default.
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