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Inferior Turbinate Trim

Basic Info: A 14-year-old male presented with chronic nasal obstruction and awake stertor. It was discovered that the patient had severe bilateral turbinate hypertrophy. A trial of Flonase and antihistamine was attempted with no improvement. It was recommended that the patient undergo a bilateral nasal turbinate reduction. This procedure is displayed step-wise in the video.

Introduction: Chronic nasal obstruction can be caused by inferior turbinate hypertrophy. This video portrays a surgical treatment for turbinate hypertrophy, a turbinate trim with a microdebrider blade.

Methods: An Afrin pledget was inserted into each nostril and lidocaine was injected into each inferior turbinate. Each turbinate was medially fractured using a freer. The microdebrider blade was used to trim the inferior 1/3 of each turbinate. A freer was used to out-fracture each inferior turbinate. Afrin pledgets were inserted into each nostril for hemostasis.

Results: The inferior one-third of each inferior turbinate was removed via a microdebrider. Patient was sent to recovery in good condition, and Afrin pledgets were removed in recovery once hemostasis was achieved. No adverse reactions were reported by the surgeon or patient.

Conclusion: Chronic nasal obstruction can be significantly improved by an inferior turbinate trim and out-fracture.

Author: Merit Turner, BS, BS

Surgeon: Gresham T. Richter, MD

Institutions:

Department of Otolaryngology-Head and Neck Surgery, Arkansas Children’s Hospital, Little Rock, AR

University of Arkansas for Medical Sciences, Little Rock, AR

A rigid zero degree endoscope was used to visualize and record the procedure. 1. Afrin soaked pledgets were inserted into each nostril inferior to the inferior turbinate 2. 1% lidocaine with epinephrine was injected into each inferior turbinate 3. The right inferior turbinate was fractured medially 4. The microdebrider was used to remove bone and soft tissue from the turbinate on the right side. The inferior 1/3 of the turbinate was removed. 5. Bipolar cautery was used for hemostasis 6. The right turbinate was out-fractured 7. An Afrin-soaked pledget was inserted into the right nostril for hemostasis 8. The left inferior turbinate was fractured medially 9. The microdebrider was used to remove bone and soft tissue from the left inferior turbinate. The inferior 1/3 of the turbinate was removed. 10. Bipolar cautery was used for hemostasis 11. The left turbinate was out-fractured 12. An Afrin-soaked pledget was inserted into the left nostril for hemostasis
Chronic nasal obstruction resistant to clinical treatment [2], turbinate hypertrophy, mouth breathing
Patients unable to tolerate anesthesia, patients with bleeding disorders
Patient was placed in the supine position and placed under general anesthesia. Orotracheal intubation was performed. Standard draping was utilized. An endoscopic tower was placed opposite the side of the patient for surgeon-viewing.
Preoperative workup typically includes a clinic visit for a chief complaint of mouth breathing, difficulty breathing through the nose, snoring, dental disturbance, or other airway-related complaints. Physical examination may include examination with an otoscope or nasal endoscopy.
Nasal septum, inferior turbinate, posterior lateral nasal artery (a branch of the sphenopalatine artery), and superior branches of the superior labial artery
Advantages: The procedure is low-risk and can improve symptoms of chronic nasal obstruction. Disadvantages: This technique has an increased risk of bleeding and a longer procedure time than alternative methods such as radiofrequency ablation, coblation, or submucous resection
This procedure is low-risk, as it is rare to have any post-operative complications [1]. The known risks of this procedure include nasal bleeding after removal of packing [1], sometimes requiring cauterization, post-operative dryness of the nasal cavity [3], infection, scarring, and persistent nasal obstruction. Additionally, removing more than the inferior 1/3 of the inferior turbinate increases the risk of empty nose syndrome (ENS).
None of the authors or surgeons involved in this video have any conflicts of interest to disclose.
Arkansas Children's Hospital, Little Rock, AR, USA University of Arkansas for Medical Science, Little Rock, AR, USA.
1. Percodani J, Nicollas R, Dessi P, Serrano E, Tiglia JM. Partial lower turbinectomy in children: indications, technique, results. Revue de laryngology-otologie-rhinologie. 1996; 117(3):175-178. https://www.ncbi.nlm.nih.gov/pubmed/9102722. Accessed July 23, 2019. 2. Roithmann R. Inferior turbinectomy: what is the best technique? Brazilian Journal of Otorhinolaryngology. 2018; 84(2):133-134. https://www.sciencedirect.com/science/article/pii/S1808869417302203?via%3Dihub. Accessed July 23, 2019. 3. Mathai J. Inerior turbinectomy for nasal onstruction review of 75 cases. Indian Journal of Otolarymgology Head and Neck Surgery. 2004; 56(1): 23-26. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3451965/. Accessed July 23, 2019.

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