Treatment for enlarged inferior turbinates

Less invasive "cold" techniques: powered submucosal inferior turbinoplasty
In a powered/submucous inferior turbinoplasty, your surgeon uses an instrument called a microdebrider (pronounced "MI-kro-duh-BREE-der") with a tiny rotating cutting tip that can be changed for individual anatomy and type of surgery. The microdebrider offers the surgeon more precision, control and speed than other surgery tools, which is why it is widely used by many ENT surgeons.

The microdebrider's precision allows the physician to remove enough tissue to correct the obstruction while preserving the mucous lining and turbinate tissue you need for healthy nasal/sinus function. It allows more controlled results because your physician immediately can see the extent of the reduction and adjust as needed during surgery.

With radiofrequency techniques, for example, the surgeon cannot tell how much the turbinates have been reduced until six to eight weeks after the procedure, which makes the outcome of surgery more unpredictable. This is partly why the powered/submucous inferior turbinoplasty appears to have better long-term results than the radiofrequency method described in a recent study.¹

The advantages of this technique include the following.

• "Cold" technique that causes no thermal (heat) injury. This is called a cold technique because it doesn't rely on heat/light energy. Electrocautery, bipolar ablation and laser cautery use heat/light energy which is harder to control or predict, making it easier for mucous membrane or bone to be damaged during your procedure.

• More complete, precise removal. Effective turbinate surgery requires a delicate balance between removing enough tissue to correct the obstruction and preserving the mucous lining you need. The microdebrider is so precise and controlled that surgeons can use it to reduce the turbinate precisely as needed for each patient and see the immediate results of their work during surgery.

• Better long-term effectiveness. A 2005 randomized, controlled, prospective, double-blinded study by Sacks et al compared powered inferior turbinoplasty and submucosal electrocautery.¹
  
  Patients in the study had a different technique performed on each side of the nose and results were compared at one month, four months, and 12 months after surgery.
  
  Follow-up evaluations at four months and 12 months showed that patients who underwent powered submucosal inferior turbinoplasties experienced significantly better long-term results compared to the electrocautery technique.

• Normal turbinate function preserved. The microdebrider and the powered/submucous inferior turbinoplasty method provide the precision, accuracy and control necessary to preserve the surface lining of the turbinates and healthy turbinate function.

• Minimally invasive. There is no external incision; only a very small opening in the turbinate where the tiny tip of the microdebrider is inserted.

The disadvantages of this technique include:

• Not effective in removing large turbinate bone when necessary

• In terms of reducing the physical obstruction, the effects are no better than with a submucosal resection of the inferior turbinate

¹Sacks R, Thornton MA, Boustred RN. Modified endoscopic turbinoplasty – long term results compared to submucosal electrocautery and submucosal powered turbinoplasty. Presented at the American Rhinologic Society, May 14, 2005.

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