Powered endoscopic submucosal partial resection of the inferior turbinate.

A 40-year-old woman presented with unilateral nasal obstruction that had persisted for 2 years despite oral and topical medications. Clinical examination revealed a hypertrophic obstruction of the right inferior turbinate (figure, A). Computed tomography (CT) of the sinuses showed that the right inferior turbinate was much larger than the left (figure, B). The patient elected to undergo powered endoscopic reduction of the right inferior turbinate (figure, C). The procedure resulted in a significant decrease in the size of the right inferior turbinate and improvement of the nasal airway (figure, D).

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Various procedures have been developed to reduce the size of hypertrophic inferior turbinates:

* Injection of a long-acting steroid was popular in the 1960s, but this strategy usually required periodic repeat injections.

* Resection of the anterior and inferior portions of the inferior turbinate was also popularized in the 1960s, and it is still performed by some surgeons today. This procedure involves using scissors or a punch forceps to amputate a large portion of the turbinate and extensive denuded tissue. However, this intervention sometimes leads to months of crusting and occasional hemorrhaging during the healing period, and it has been the subject of debate for many years.

* Cauterization of the inferior turbinate, either chemically or with electrocautery, has also been used frequently for decreasing turbinate soft-tissue bulk. This procedure can also result in crusting and damage to the turbinate mucosa.

* Laser surgery introduced in the 1980s was adapted to turbinate reduction, and it gave us yet another surgical technique. Both C[O.sub.2] and KTP laser procedures were popular, but they too caused crusting and mucosal damage.

* The introduction of powered instrumentation in the 1990s provided us with yet another tool for inferior turbinate reduction, one that remains popular today. (1) This procedure involves the use of powered instrumentation to contour the medial and inferior surfaces of the inferior turbinate, thereby reducing the excessive bulk of the tissue without destroying the majority of the inferior turbinate. (2)

Removal of a portion of the inferior turbinate via submucosal dissection with conventional instruments has been an option for many years. However, according to Donald Leopold, MD, the use of powered instrumentation to submucosally resect portions of the inferior turbinate has become preferable since the development of small, specific microdebrider blades for this purpose (oral communication, September 2005). After injection of a local anesthetic solution, a small incision is made in the anterior tip of the turbinate. A submucosal dissection of soft tissue and thin bone is carried out longitudinally and parallel to the medial and inferior surfaces of the inferior turbinate. This results in a marked decrease in turbinate bulk with preservation of the turbinate mucosa.

References

(1.) Davis WE, Nishioka GJ. Endoscopic partial inferior turbinectomy using a power microcutting instrument. Ear Nose Throat J 1996;75:49-50.

(2.) Mirante JP, Christmas DA Jr., Yanagisawa E. Powered endoscopic turbinate surgery. In: Yanagisawa E, Christmas DA Jr., Mirante JE eds. Powered Instrumentation in Otolaryngology-Head and Neck Surgery. San Diego: Singular Thomson Learning; 2001 : 174-8.

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

From the Department of Otolaryngology, University of South Florida College of Medicine, Tampa, and the Halifax Medical Center, Daytona Beach, Fla. (Dr. Mirante and Dr. Christmas); 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).