Endoscopic view of 'mulberry hypertrophy' of the inferior turbinates.

A 50-year-old woman presented with a long-term history of nasal and sinus congestion. She had been treated by several physicians with various medications but failed to obtain significant relief of symptoms. Endoscopic nasal examination revealed a polypoid formation with "mulberry hypertrophy" of the posterior end of the inferior turbinates (figure, A). Computed tomography (CT) of the paranasal simises revealed evidence of chronic sinusitis and the mulberry configuration of the posterior inferior turbinates (figure, B).

[FIGURES A-B OMITTED]

The patient elected to undergo endoscopic nasal and sinus surgery. At the time of surgery, the polypoid hypertrophy of the posterior interior turbinates was removed with a microdebrider (figure, C), and the surface was smoothly contoured (figure, D). The site of the surgery was lightly electrocoagulated, which relieved the obstruction at the posterior choanae. The patient healed well and reported significant relief of her nasal congestion.

[FIGURES C-D OMITTED]

Polypoid formation at the posterior tip of the inferior turbinates is common and usually bilateral. The overall effect of mulberry hypertrophy is obstruction of the posterior nasal cavity near the posterior choanae. (1) Once the endoscopic diagnosis is confirmed, the removal of the hypertrophic tissue usually results in relief of the obstructive symptoms.

The use of a microdebrider to remove polypoid tissue or to contour the turbinate tissue has been described as helpful by Mirante et al. (2) At the conclusion of the surgical procedure, electrocautery is recommended because the posterior end of the inferior turbinates is usually very vascular.

References

(1.) Yanagisawa E. Nasal endoscopic anatomy. In: Yanagisawa E. Color Atlas of Diagnostic Endoscopy in Otorhinolaryngology. New York: Igaku Shoin, 1997.

(2.) Mirante JP. Christmas DA. Yanagisawa E. Powered endoscopic turbinate surgery. In: Yanagisawa E. Christmas DA, Mirante JR Powered Instrumentation in Otolaryngology-Head and Neck Surgery. San Diego: Singular, 2001.

Dewey A. Christmas, MD; Joseph P. Mirante, MD; Eiji Yanagisawa, MD

From the Department of Otolaryngology, University of South Florida College of Medicine, Tampa. and the Halifax Medical Center, Daytona Beach, Fla. (Dr. Christmas and Dr. Mirante): and the Southern New England Ear, Nose, Throat, and Facial Plastic Surgery Group; the Section of Otolaryngology, Hospital of St. Raphael: and the Section of Otolaryngology, Yale University School of Medicine, New Haven, Conn. (Dr. Yanagisawa).