ABSTRACT
La hipertrofia de cornetes inferiores representa una de las principales causas de obstrucción nasal en pacientes pediátricos. En estudios recientes se ha observado un aumento significativo de esta patología en niños que no responden a terapia médica. La evidencia disponible recomienda la cirugía como tratamiento de elección en la obstrucción nasal refractaria en niños con cornetes hipertróficos. Sin embargo, hasta la fecha no existen criterios formales de derivación a cirugía en la población pediátrica y los estudios en infantes son limitados. Al mismo tiempo, la falta de consenso no ha permitido recomendar una técnica quirúrgica en estos pacientes por sobre otras. Por lo tanto, se hace necesario profundizar las diferentes alternativas disponibles, considerando y optando por aquellas que presenten mayores beneficios y menor riesgo de complicaciones. En la presente revisión se estudió la evidencia disponible hasta el momento sobre este tema en la población pediátrica y además se realizó un análisis de la efectividad y complicaciones de las diferentes técnicas disponibles.
Inferior turbinate hypertrophy represents one of the leading causes of nasal obstruction in pediatric patients. Recent studies have observed a significant increase in turbinate hypertrophy in children that does not respond to medical treatment. The latest evidence recommends inferior turbinoplasty for treating nasal obstruction in children with hypertrophic turbinates. However, until today there are no formal criteria for referral to surgery in the pediatric population, and studies in children are limited. At the same time, the absence of consensus has not allowed the recommendation of one surgical technique over others in these patients. This is why it is necessary to deepen the available alternatives and choose those with more significant benefits and a lower risk of complications. In this review, we study available evidence about this topic in the pediatric population and analyze the effectiveness and complications of different known techniques.
ABSTRACT
Resumen La obstrucción nasal es una de las causas más frecuentes de consulta otorrinolaringológica general. Diversas estructuras juegan un rol en la mantención de una adecuada función respiratoria nasal, incluyendo el tabique, los cornetes, las paredes laterales y las alas nasales. La cirugía del tabique y de los cornetes inferiores son los procedimientos más comúnmente realizados y aunque son efectivos en un gran porcentaje de los casos, en ocasiones se deben intervenir otras estructuras nasales para corregir adecuadamente la obstrucción. La cirugía con fines primariamente funcionales de las válvulas nasales externa e interna, de la punta y/o de la pirámide ósea se ha denominado "rinoplastía funcional". Dada la importancia de estas estructuras para la recuperación de una adecuada permeabilidad nasal estática y dinámica, el diagnóstico y manejo quirúrgico de estas condiciones debe ser de dominio del otorrinolaringólogo.
Abstract Nasal obstruction is one of the most frequent complaints in general otorhinolaryngology practice. Different structures have a role in maintaining an adequate nasal breathing function, including the septum, turbinates, lateral sidewalls and nasal alae. Surgery of the nasal septum and inferior turbinates are the most commonly performed procedures and, although effective in most cases, occasionally other nasal structures must be intervened to correctly address the sites of obstruction. The term "functional rhinoplasty" has been coined for surgery of the external and internal nasal valves, nasal tip and/or bony pyramid, with primarily functional objectives. Given the importance of these structures for restoring an adequate static and dynamic nasal patency, diagnosis and management of these conditions must be dominion of the otorhinolaryngologist.
Subject(s)
Humans , Rhinoplasty/methods , Nasal Obstruction/surgery , Nasal Septum/surgery , Turbinates/surgery , Nasal Obstruction/diagnosis , Treatment OutcomeABSTRACT
La obstrucción nasal es un motivo de consulta habitual en otorrinolaringología, siendo una de las causas más frecuentes la hipertrofia de cornete inferior, la que se puede manejar con cirugía cuando falla el tratamiento médico. En las últimas décadas se han desarrollado múltiples técnicas quirúrgicas y tecnología asociada, sin embargo, no hay un consenso establecido sobre cuál es la mejor opción para el manejo de esta patología. Se realizó revisión bibliográfica, se enuncian los métodos quirúrgicos disponibles, teniendo en cuenta beneficios, complicaciones probables y resultados de cada uno. La cirugía de cornete inferior tiene resultados favorables en pacientes con cornetes hipertróficos que no responden a manejo médico. Hasta la fecha la turbinoplastía con microdebridador ha mostrado superioridad en cuanto a resultados a largo plazo y menor tasa de complicaciones. La evidencia disponible hasta la fecha carece de homogeneidad en cuanto a métodos de selección de pacientes, medición de resultados y tiempo de seguimiento, por lo que se necesitan a futuro estudios prospectivos controlados para reevaluar los métodos descritos.
Nasal obstruction is a common complaint, one of the most frequent causes being inferior turbinate hypertrophy, which can be managed with surgery when medical treatment fails. In the last decades, multiple surgical techniques and associated technology have been developed, however, there is no established consensus on what is the best option for the management of this pathology. Literature review, the available surgical methods are stated, taking into account benefits, probable complications and results of each technique. The surgery of inferior turbinate has favorable results in patients with hypertrophic turbinates that do not respond to medical management. To date, microdebrider turbinoplasty has shown superiority in terms of long-term results and lower complication rates. The evidence available to date lacks homogeneity in terms of patient selection methods, measurement of results and follow-up time, so prospective controlled studies are needed in the future to reassess the described methods.
Subject(s)
Humans , Otorhinolaryngologic Surgical Procedures/methods , Turbinates/surgery , Turbinates/pathology , Hypertrophy/surgeryABSTRACT
Abstract Introduction: The most common cause of septoplasty failure is inferior turbinate hypertrophy that is not treated properly. Several techniques have been described to date: total or partial turbinectomy, submucosal resection (surgical or with a microdebrider), with turbinate outfracture being some of those. Objective: In this study, we compared the pre- and postoperative lower turbinate volumes using computed tomography in patients who had undergone septoplasty and compensatory lower turbinate turbinoplasty with those treated with outfracture and bipolar cauterization. Methods: This retrospective study enrolled 66 patients (37 men, 29 women) who were admitted to our otorhinolaryngology clinic between 2010 and 2017 because of nasal obstruction and who were operated on for nasal septum deviation. The patients who underwent turbinoplasty due to compensatory lower turbinate hypertrophy were the turbinoplasty group; Outfracture and bipolar cauterization were separated as the out fracture group. Compensatory lower turbinate volumes of all patients participating in the study (mean age 34.0 ± 12.4 years, range 17-61 years) were assessed by preoperative and postoperative 2 month coronal and axial plane paranasal computed tomography. Results: The transverse and longitudinal dimensions of the postoperative turbinoplasty group were significantly lower than those of the out-fracture group (p = 0.004). In both groups the lower turbinate volumes were significantly decreased (p = 0.002, p < 0.001 in order). The postoperative volume of the turbinate on the deviated side of the patients was significantly increased: tubinoplasty group (p = 0.033). Conclusion: Both turbinoplasty and outfracture are effective volume-reduction techniques. However, the turbinoplasty method results in more reduction of the lower turbinate volume than outfracture and bipolar cauterization.
Resumo Introdução: A causa mais comum de falha da septoplastia é a hipertrofia das conchas inferiores não tratada adequadamente. Diversas técnicas foram descritas até o momento: turbinectomia total ou parcial, ressecção da submucosa (cirúrgica ou com microdebridador) e a fratura lateral. Objetivo: Neste estudo, comparamos os volumes pré e pós-operatório da concha inferior com hipertrofia compensatória com o uso de tomografia computadorizada entre pacientes submetidos a septoplastia e turbinoplastia ou fratura lateral com cauterização bipolar. Método: Este estudo retrospectivo incluiu 66 pacientes (37 homens e 29 mulheres) internados em nosso serviço de otorrinolaringologia entre 2010 e 2017 por obstrução nasal e submetidos à cirurgia por desvio de septo nasal. Os pacientes submetidos à turbinoplastia devido à hiperplasia compensatória da concha inferior formaram o grupo turbinoplastia; aqueles submetidos à fratura lateral e cauterização bipolar foram separados, formaram o grupo fratura lateral. Os volumes compensatórios da concha inferior de todos os pacientes que participaram do estudo (idade média de 34,0 ± 12,4 anos, faixa de 17 a 61 anos) foram avaliados por tomografia computadorizada dos seios paranasais nos planos axial e coronal no pré-operatório e aos dois meses do pós-operatório. Resultados: As dimensões transversais e longitudinais do grupo turbinoplastia no pós-operatório foram significantemente menores do que as do grupo de fratura lateral (p = 0,004). Em ambos os grupos, os volumes da concha inferior diminuíram significantemente (p = 0,002, p < 0,001, respectivamente). O volume pós-operatório da concha do lado do desvio aumentou significantemente no grupo turbinoplastia (p = 0,033). Conclusão: Tanto a turbinoplastia como a fratura lateral são técnicas efetivas de redução de volume. No entanto, a turbinoplastia causa maior redução do volume da concha inferior do que a fratura lateral com cauterização bipolar.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Turbinates/surgery , Turbinates/pathology , Nasal Obstruction/surgery , Nasal Septum/surgery , Retrospective Studies , Treatment Outcome , Preoperative Period , Nasal Surgical Procedures/methods , HypertrophyABSTRACT
In this review, we’re highlighting the most recentadvancements in the diagnosis and management of rhinitismedicamentosa. A topic which has not reviewed recently.Rhinitis medicamentosa is relatively common conditionresulting from longer than recommended use of nasaldecongestant. There still no clear diagnostic criteria todiagnose RM. In addition, the pathophysiological explanation toRM has been researched, however with no solid conclusionhas been developed. Rhinitis medicamentosa can beprevented by proper management of the primary disease. Theimportant goals in treating RM is to first, stop nasaldecongestant then to treat the underlying condition properly.Corticosteroids also has been used and are effective in relivingRM symptoms. Other new less invasive techniques has beendeveloped recently in treating nasal congestion caused by RM,however, part of them are still under research and has to beproved on accurate samples. Refractory cases that are notresponsive to previously mentioned management can benefit
ABSTRACT
Organized hematoma of nasal cavity has been reported previously in several articles. However, few studies reported the cause of organized hematoma. Recently, 22-years-old male who underwent coblation associated turbinoplasty one year ago visited our clinic with symptom of nasal obstruction. He was diagnosed as organized hematoma in left maxillary sinus. We performed endoscopic sinus surgery and successfully removed it. Therefore, we report a case of organized hematoma origin from maxillary sinus after coblation associated turbinoplasty.
Subject(s)
Humans , Male , Hematoma , Maxillary Sinus , Nasal Cavity , Nasal ObstructionABSTRACT
BACKGROUND AND OBJECTIVES: High dorsal deflection of the nasal septum around cartilage or the perpendicular plate is technically difficult to correct. The objective of this study was to assess whether correction of high septal deviation during septoplasty is necessary to improve nasal airflow. PATIENTS AND SURGICAL METHOD: Twenty-one patients with high septal deviation around the septal cartilage or the perpendicular plate were included in this study. In order to improve nasal obstruction, septoturbinoplasty was performed, but high septal deviation was not corrected. Subjective and objective improvements were evaluated using the visual analogue scale and acoustic rhinometry 1 month before and 3 months after surgery. RESULTS: After correction of nasal septum deviation except high septal deviation and reduction of turbinate mucosal volume, postoperative nasal volume and minimum cross-sectional area were significantly increased. Subjective symptom scales for nasal obstruction, rhinorrhea, sneezing, and posterior nasal drip were considerably improved after limited septoturbinoplasty in patients who still had high dorsal deflection of the nasal septum. CONCLUSION: Our findings suggest that limited septoturbinoplasty without excessive resection of high dorsal deflection of the nasal septum can improve nasal airflow and reduce subjective symptoms, including nasal obstruction.
Subject(s)
Humans , Cartilage , Methods , Nasal Obstruction , Nasal Septum , Rhinometry, Acoustic , Sneezing , Turbinates , Weights and MeasuresABSTRACT
Fundamento: la reducción quirúrgica del cornete inferior es la conducta de elección en pacientes con rinitis crónica hipertrófica no infecciosa que no responden al tratamiento farmacológico; aunque existen otras técnicas quirúrgicas para ello, todavía son insuficientes las evidencias que soportan su eficacia. Objetivo: describir las características clínicas y los resultados posquirúrgicos en pacientes con rinitis crónica hipertrófica no infecciosa tratados mediante turbinoplastia inferior endoscópica . Metodología: estudio descriptivo de serie de casos en pacientes mayores de 15 años con rinitis crónica hipertrófica no infecciosa tratados mediante turbinoplastia inferior endoscópica en el Centro Nacional Cirugía Mínimo Acceso, entre el 1 de mayo de 2010 al 30 de junio de 2012. Los pacientes se siguieron por 6 meses. Resultados: se incluyeron 36 pacientes, el 63,9 % eran masculinos; el 69,4 % presentó rinitis alérgica. Predominó la obstrucción nasal asociada a rinorrea, prurito y cefalea ( 44,4 %), así como la hipertrofia grado II (58,3 %). Después de la cirugía todos los pacientes mejoraron y solo el 8,3 % presentó complicaciones. Conclusiones: se obtuvieron resultados favorables con el uso de la turbinoplastia inferior endoscópica , fundamentalmente por el alivio de los síntomas y por la escasa presentación de complicaciones.
Background: the surgical reduction of the inferior turbinate is the treatment of choice for patients with non-infectious chronic hypertrophic rhinitis unresponsive to drug treatment; although there are other surgical techniques for this condition, evidence supporting its effectiveness is still insufficient. Objective: to describe the clinical characteristics and postoperative outcomes in patients with non-infectious chronic hypertrophic rhinitis treated by inferior endoscopic turbinoplasty . Methodology: descriptive case series study of patients over 15 years with non-infectious chronic hypertrophic rhinitis treated by inferior endoscopic turbinoplasty in the Minimum Access National Surgery Center from May 1, 2010 to June 30, 2012. The p atients were followed for 6 months. Results: 36 patients were included , 63.9% were male ; 69.4 % had allergic rhinitis. N asal obstruction associated with rhinorrhea , pruritus and headache ( 44.4 %) and grade II hypertrophy ( 58.3 %) predominated . After surgery all patients improved and only 8.3 % had complications . Conclusions : with the use of endoscopic inferior turbinoplasty favorable results were obtained , mainly due to the relief of symptoms and the limited development of complications.
Subject(s)
Humans , Turbinates/abnormalities , Turbinates/surgery , Epidemiology, DescriptiveABSTRACT
BACKGROUND AND OBJECTIVES: The study aimed to evaluate the long term efficacy of micro-debrider assisted inferior turbinoplasty (MAIT) compared to coblation assisted inferior turbinoplasty (CAIT) for hypertrophic inferior turbinates. SUBJECTS AND METHOD: From January 2008 to December 2008 inclusively, 96 patients with persistent hypertrophic inferior turbinates mucosa refractory to medical therapy were enrolled into this study. All patients were suffering from nasal obstruction and related symptoms. Overall, 56 patients were treated with microdebrider assisted inferior turbinoplasty (MAIT group) and 40 patients were treated with coblation assisted inferior turbinoplasty (CAIT group). Postoperative changes in degree of nasal obstruction, sneezing, rhinorrhea, minimal cross sectional area (MCA), and nasal volume from the nostril to 7 cm posteriorly (V7), operation time, duration of crust formation, intraoperative bleeding and delayed bleeding were compared between the two surgical methods prospectively in the 1st and 6 months, and in the 1st and 2nd years after the procedure. Also patient's satisfaction with procedure was evaluated. RESULTS: The nasal obstruction and related nasal symptoms improved significantly in MAIT group and persisted within the periods of 2 years after surgery, while in CAIT group the significant improvements took place in the 1st and 6th months after surgery but no significant improvements from 1 to 2 years after were noted. Nasal patency (MCA and V7) also showed more improvement and persistence in MAIT group than CAIT group. There were no significant differences in operation time and intraoperative bleeding and delayed bleeding but the duration of crust formation was significantly shorter in MAIT group. And patient satisfaction in the MAIT group was higher than that in the CAIT group. CONCLUSION: From the analysis of this study, it can be said that MAIT is more effective and satisfactory for the long term relief of nasal obstruction, related nasal symptoms and reduction of hypertrophic inferior turbinate mucosa than CAIT.
Subject(s)
Humans , Hemorrhage , Hypogonadism , Mitochondrial Diseases , Mucous Membrane , Nasal Obstruction , Ophthalmoplegia , Patient Satisfaction , Prospective Studies , Sneezing , Stress, Psychological , TurbinatesABSTRACT
BACKGROUND AND OBJECTIVES: There are many operative methods for allergic rhinitis such as partial or total turbinectomy, submucosal resection. Laser- assisted conchotomy (LACON) and coblation-assisted partial turbinoplasty (CAPT) are recently being commonly performed for minimal invasive surgery. The aim of this study is to compare the subjective and objective results in the groups of patients with allergic rhinitis who underwent LACON or CAPT after long term follow up. MATERIALS AND METHODS: From January 2006 to January 2007, 64 patients with allergic rhinitis refractory to medical therapy who underwent LACON or CAPT were enrolled in this study. 28 patients had LACON therapy and 36 patients underwent CAPT randomly. The symptom of allergy, duration of crust formation, and nasal patency in acoustic rhinometry were analyzed in months 3, 6, 9, 12 after surgery. RESULTS: With the Visual Analogue Scale (VAS), the patients who received LACON all reported significant differences in allergic symptoms. However, patients who received CAPT reported significant differences only in nasal obstruction and rhinorrhea. There were no significant differences in both groups in regard to nasal patency change (nasal volume, cm3) and duration of crust formation. CONCLUSION: As LACON is effective on all symptoms and CAPT is effective only on nasal obstruction and rhinorrhea, the procedures can be performed respectively, depending on the symptoms of patients.
Subject(s)
Humans , Hypersensitivity , Nasal Obstruction , Rhinitis , Rhinitis, Allergic, Perennial , Rhinometry, AcousticABSTRACT
BACKGROUND AND OBJECTIVES: Various surgical methods have been tried to relieve the symptoms of nasal obstruction in patients with inferior turbinate hypertrophy. Recently, coblators that use radiofrequency and microdebriders are increasingly used in turbinate surgery. The aim of this study was to compare the long-term postoperative outcome between the coblator-assisted and microdebrider-assisted partial turbinoplasty. SUBJECTS AND METHOD: We selected 60 patients who had nasal obstruction and hypertrophied turbinate mucosa that was refractory to medical treatment. Thirty patients were treated with coblator (group 1) and 30 patients were treated with microdebrider (group 2). Postoperative changes in degree of nasal obstruction were evaluated prospectively at 3, 6 and 12 months after the procedure. Cross-sectional area of second notch and volume of nasal cavity were compared at 12 months after operation. Operation time, duration of crust formation, postnasal drip and postoperative bleeding were also compared. RESULTS: Nasal obstruction was improved significantly in both groups. However, statistical significance of improvement and rate of patient's satisfaction at 12 months after surgery was higher in group 2. There were no significant differences in the degree of postnasal drip, operation time and duration of crust formation between two groups. CONCLUSION: This study suggests that microdebrider-assisted partial turbinoplasty is more effective and satisfactory in long-term relief of nasal obstruction and reduction of mucosal volume in the anterior head of inferior turbinate.
Subject(s)
Humans , Head , Hemorrhage , Hypertrophy , Mucous Membrane , Nasal Cavity , Nasal Obstruction , Prospective Studies , TurbinatesABSTRACT
BACKGROUND AND OBJECTIVES: Conventional turbinoplasty and laser-assisted partial turbinoplasty (LAPT) are commonly performed to control nasal obstruction secondary to inferior turbinate hypertrophy. Coblation, one of radiofrequency electrosurgeries, has recently been introduced as a new treatment modality for turbinate surgery. The aim of the current study is to compare the postoperative outcome of Coblation-assisted partial turbinoplasty (CAPT) with that of LAPT. MATERIALS AND METHOD: Forty-one patients with nasal obstruction due to inferior turbinate hypertrophy refractory to medical therapy were prospectively evaluated with a follow-up period of 6 months. Twenty-one patients (42 sides) were treated with LAPT, and 20 patients (39 sides) with CAPT. Postoperative changes in degree of nasal obstruction, minimal cross-sectional area (MCA) and nasal volume from the nostril to 5 cm posteriorly (V5), operation time, duration of crust formation, operation-associated pain, intraoperative bleeding and episodes of delayed bleeding were compared between the two surgical methods. RESULTS: Crust was formed for a shorter postoperative period and operation-associated pain was less in the LAPT group. Nasal patency (MCA and V5) was more improved and operation time was shorter in the CAPT group. However, there were no significant differences in improvement of nasal obstruction and operation-associated bleeding between the two groups. CONCLUSION: Thorough knowledge of advantages and limitations of LAPT and CAPT is required for clinicians to make appropriate use of surgical tools for the given patient characteristics and medical environment.
Subject(s)
Humans , Electrosurgery , Follow-Up Studies , Hemorrhage , Hypertrophy , Nasal Obstruction , Postoperative Period , Prospective Studies , TurbinatesABSTRACT
BACKGROUND: Septoplasty with turbinate surgery is common surgical treatment in patients with septal deviation and chronic hypertrophic rhinitis. The aim of this study was to evaluation objective outcomes of septoplasty with turbinate surgery by analysis of subjective symptom score with objective acoustic rhinometric test before and after surgery, prospectively. MATERIALS AND METHODS: We reviewed 45 adult patients which were done septoplasty with bilateral turbinectomy or turbinoplasty and followed up at least 3 months by one rhinologist from November 1999 to April 2000, prospectively. We analyzed subjective symptom score, minimal cross-sectional area (MCA), C-notch cross-sectional area, and total volume of both nasal cavity before and after surgery. Correlation test was studied between symptom improvement and acoustic rhinometric results. RESULTS: Twenty nine cases were male and sixteen cases female. The average age was 26.9 year-old (range: 17 to 57 years). There was significantly improvement of symptom score in postoperative 3 months (p<0.05). There was significantly increased C-notch cross-sectional area and total volume in postoperative 3 months. Symptoms improvement were associated with acoustic rhinometric profiles, but, there was not significantly correlation. CONCLUSION: Septoplasty with turbinate surgery is considered to be effective for nasal obstruction in patients with septal deviation and turbinate hypertrophy. Acoustic rhinometric test is favorable objective test for evaluation of symptom improvement after septal surgery.