Turbinate reduction is a surgical procedure to reduce the size of one or more of the small curved bones in the nose, known as turbinates, in order to open clogged nasal passages and improve breathing. There are three pairs of turbinates in the nose, classified as inferior, middle and superior. Their function is to warm, filter and humidify air as it circulates through the nose and into the lungs. Since they serve as filters, the turbinates help to protect the body from irritants and stave off infection.
Reasons for Turbinate Reduction
Turbinate reduction is performed when a patient's turbinate is abnormally large, creating a nasal obstruction. The turbinates may swell in response to ear, nose and throat allergies or upper respiratory infections, resulting in a number of troubling symptoms. These symptoms may include:
- Chronic nasal congestion
- Difficulty breathing through the nose
- Recurrent or chronic sinus infections
- Chronic nosebleeds
- Migraine headaches
- Sleep apnea
If traditional treatments, such as nasal decongestants, antihistamines, allergy shots and antibiotics do not resolve these problems, surgical intervention is usually recommended.
Turbinate Reduction Procedure
Turbinate reduction is frequently performed in conjunction with corrective surgery for a deviated septum, known as a septectomy. Turbinate reduction may be performed using a few different surgical methods, depending on the patient's overall medical condition and the nature of the problem.
During a turbinectomy, either part or all of the inferior turbinate is removed. This surgery may be performed with or without the assistance of an endoscope, a flexible illuminated tube inserted into the nose. A turbinectomy is performed under general anesthesia with the use of a microdebrider, an instrument combining a small rotary blade to shave the tissue and a suction device to clear it away.
During turbinoplasty, the affected bones may be repositioned within the nose, a technique called outfracture. Outfracture is usually performed with some shaving of excess tissue.
Radiofrequency or Laser Ablation
Radiofrequency and laser ablation both make use of an endoscope inserted into the patient's nose. Depending on which method is used, the probe has either a source of laser light or one of radioenergy attached to it. The laser or radiofrequency energy will be used to shrink the turbinate to a healthier size. This procedure is the least invasive of the three and may be performed in the doctor's office using local anesthesia. If the turbinate regenerates, this relatively simple procedure may be repeated at a later date.
It may take up to 2 months to heal completely after any of the turbinate reduction procedures.
Risks of Turbinate Reduction
While turbinate reduction in any of its forms is a safe procedure, surgery always involves an element of risk. Patients undergoing any surgical procedure may be at risk of the following:
- Excessive bleeding
- Breathing problems
- Adverse reactions to anesthesia or medication
- Heart attack or stroke
Risks for this particular surgery may include:
- Regrowth of turbinate tissue
- Formation of excessive scar tissue in the nose
- A puncture of the septum, the membrane dividing the nostrils
- Numbness in the nose
- Buildup of nasal fluid
After turbinate reduction surgery, some individuals may experience a change in their sense of smell.
Recovery from Turbinate Reduction
Since turbinate reduction surgery is performed as an outpatient procedure, recovery is usually relatively short. There is no visible scarring since the surgeon operates through the nose, although there may be some minimal swelling or bruising which will disappear quickly. The patient may experience some facial pain which can be relieved with pain medication. The nose may feel clogged until the swelling goes down. Although the surgeon uses electrocautery to seal off the wound after surgery, nasal packing may be necessary to stem excessive bleeding. This packing, which the patient may find uncomfortable, is removed soon after the surgery.
There may be more than usual nasal secretion for a few weeks, possibly tinged with blood. Patients are advised to use a saline nasal spray to keep the area clear and well-irrigated. Most patients can resume a limited routine after about a week and experience a full recovery after a few weeks.
Follow-up visits with the doctor are necessary to make sure that the nasal cavities are kept clean and that healing is proceeding well. After turbinate reduction, patients are advised to avoid:
- Heavy lifting or bending
- Vigorous nose blowing
- Medications that may promote bleeding
- Smoke, dust or fumes
Once the swelling goes down and healing is complete the patient's quality of life should be greatly improved.