The turbinectomy is the surgery done to reduce the size of nasal turbinates.
The turbinates are a shell-shaped network of bones and tissues within the nasal passage. There are three turbinates, each on the sides of the nasal cavities. They are called superior, middle, and inferior turbinates. Turbinates are made of bone and are covered by a soft tissue known as “mucosa.” These help regulate the airflow and the temperature of the air entering the nose and maintain the moisture levels of the nasal pathways. The turbinates can become swollen, enlarged, or displaced, causing nose blockage and breathing difficulties. Turbinectomy, turbinoplasty, or turbinate reduction is indicated in such cases if medical therapy fails.
Why is turbinectomy done?
The turbinates can become swollen, enlarged, or displaced because of various reasons. Problems associated with turbinates may go away on their own or may require medical treatment. If medical treatment fails, then the surgical turbinate reduction is indicated.
Some common causes of turbinate enlargement include:
What happens during turbinectomy?
The procedure is performed by an ENT (ear, nose, and throat) surgeon under general or local anesthesia. There are several techniques used to reduce the size of the turbinates. They are all performed inside the nose, and some are less invasive than others.
Cauterization, coblation, and radiofrequency turbinate reduction
The turbinates are shrunk without removing any underlying bone or tissue. A specialized needle-like device is inserted into the turbinate. The turbinate is heated through the needle using a heat source or energy waves. This causes the formation of scar tissue, and it shrinks the turbinates. The procedure takes around 12 to 20 minutes and can be performed under local anesthesia. Patients can go home after the surgery and return to their normal activities. Pain and swelling associated with the procedure may be present, but this resolves in a few days.
Surgical turbinate removal
This procedure is more invasive but performed inside the nose without any visible cuts externally. It is usually performed under general anesthesia. It may be combined with a nasal septum or sinus surgery. In some cases, only parts of the turbinates are surgically removed. During surgical reduction, the surgeon cuts into the turbinates to remove some of the bone underneath and reduce their size. Some of the tissue around the turbinate may be shaved away as well.
Most patients can go home the same day or the day after surgery. The nose may be packed and dressed for up to 48 hours. Patients may experience swelling, bruising, crusting, and bloodstained nasal discharge after the surgery; this usually resolves in a week. Painkillers, antibiotics, and nasal and oral decongestants may be prescribed. Most patients can return to work in about a week and go to their usual preoperative routine in about 3 weeks. Complete recovery can take 1-2 months if septal and/or sinus surgery are also performed.
What are the risks of turbinectomy?
Turbinate reduction surgery is a routinely performed procedure. Complications are rare and are usually temporary. Some possible risks associated with the procedure include:
- Nasal discharge
- Crusting in the nose
- Dryness in the nose
- Recurrence of the problem (turbinate tissue may regrow after surgery), requiring further treatment
- Empty nose syndrome: This is an extremely rare complication that can sometimes occur after surgery in the nose if too much bone and tissue are removed. The nasal cavity becomes wide open and roomy. It is characterized by a dry nose, nasal discharge, crusting, nose bleeds, headache, and a feeling that the nose is blocked despite the nasal cavity being wide. There is no definitive cure for this condition. The treatment mainly involves providing symptomatic relief.
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Mitchell RB. Pediatric Turbinate Reduction By Coblation. Operative Techniques in Otolaryngology-Head and Neck Surgery. 2009;20(3):172-174. https://www.sciencedirect.com/science/article/abs/pii/S1043181009000827
Scheithauer MO. Surgery of the turbinates and "empty nose" syndrome. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2010;9:Doc03. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3199827/