Inferior nasal turbinate mucosa shrinkage prior to surgery under local anaesthesia

Introduction and Objectives: Chronic rhinitis-related complaints may result from isolated hypertrophy of the inferior nasal turbinates. If the symptoms persist despite conservative management, turbinoplasty is indicated. However, the nasal mucosa lining the inferior turbinates seems decongested immediately before the surgery performed under local anaesthesia, compared to the examination when the patients were entered for surgery. The study aimed to confirm this observation and to hypothesize as to the reasons for its occurrence.Patients and MethodsThe measurements of the longest distances between the medial rim of the inferior nasal turbinate mucosa and nasal septum and the shortest distances between the lower rim of the turbinate and floor of the nasal cavity in the inferior part of both common nasal meatus, were carried out on photos taken during endoscopic examinations: the one entering the patient for turbinoplasty, and the other immediately before the procedure. The results in this group were compared to those obtained from patients operated on under general anaesthesia.ResultsIn 130 patients aged 18-60 (mean=40.7) years, operated on under local anaesthesia, the sum of the mean distances between the nasal septum and the medial rim of the lower turbinate in both nasal cavities, was 3.4mm during the first examination, and 4.5mm (p=.0008) during the second one. In the group of 42 participants aged 26-47, mean=36.8 years operated on under general anaesthesia, the values were: 4.8mm and 3.6mm (p=.02), respectively. The differences were significantly smaller in the smokers (.3) compared to non-smokers (1.3; p=.04) mm.ConclusionsRecords of the entering examination must be considered before turbinoplasty under local anaesthesia. (AU)

Introducción y objetivos: Las molestias relacionadas con la rinitis crónica pueden ser resultado de la hipertrofia aislada de los cornetes nasales inferiores. Si los síntomas persisten a pesar del tratamiento conservador, está indicada la turbinoplastia. Sin embargo, la mucosa nasal que recubre los cornetes inferiores parece descongestionarse inmediatamente antes de la cirugía realizada con anestesia local, en comparación con el examen realizado al ingresar los pacientes para cirugía. El estudio tuvo como objetivo confirmar esta observación y formular hipótesis sobre las razones de su ocurrencia.Pacientes y métodosSe realizaron mediciones de las distancias más largas entre el borde medial de la mucosa del cornete nasal inferior y el tabique nasal, así como las distancias más cortas entre el borde inferior del cornete y el suelo de la cavidad nasal en la parte inferior de ambos meatos nasales comunes, en las fotografías tomadas durante los exámenes endoscópicos: las realizadas al ingresar el paciente para turbinoplastia y las realizadas inmediatamente antes del procedimiento. Los resultados en este grupo se compararon con los obtenidos en pacientes operados bajo anestesia general.ResultadosEn 130 pacientes de 18 a 60 años (media = 40,7) años, operados bajo anestesia local, la suma de las distancias medias entre el tabique nasal y el borde medio del cornete inferior en ambas cavidades nasales fue de 3,4 mm durante el primer examen, y 4,5 mm (p = 0,0008) durante el segundo. En el grupo de 42 participantes de 26 a 47 años, promedio = 36,8 años operados bajo anestesia general, los valores fueron: 4,8 mm y 3,6 mm (p = 0,02), respectivamente. Las diferencias fueron significativamente menores en los fumadores (0,3) en comparación con los no fumadores 1,3 mm (p = 0,04).ConclusionesDeben considerarse los registros del examen realizado durante el ingreso previo a la turbinoplastia bajo anestesia local. (AU)

Inferior nasal turbinate mucosa shrinkage prior to surgery under local anaesthesia.

INTRODUCTION AND OBJECTIVES: Chronic rhinitis-related complaints may result from isolated hypertrophy of the inferior nasal turbinates. If the symptoms persist despite conservative management, turbinoplasty is indicated. However, the nasal mucosa lining the inferior turbinates seems decongested immediately before the surgery performed under local anaesthesia, compared to the examination when the patients were entered for surgery. The study aimed to confirm this observation and to hypothesize as to the reasons for its occurrence. PATIENTS AND METHODS: The measurements of the longest distances between the medial rim of the inferior nasal turbinate mucosa and nasal septum and the shortest distances between the lower rim of the turbinate and floor of the nasal cavity in the inferior part of both common nasal meatus, were carried out on photos taken during endoscopic examinations: the one entering the patient for turbinoplasty, and the other immediately before the procedure. The results in this group were compared to those obtained from patients operated on under general anaesthesia. RESULTS: In 130 patients aged 18-60 (mean=40.7) years, operated on under local anaesthesia, the sum of the mean distances between the nasal septum and the medial rim of the lower turbinate in both nasal cavities, was 3.4mm during the first examination, and 4.5mm (p=.0008) during the second one. In the group of 42 participants aged 26-47, mean=36.8 years operated on under general anaesthesia, the values were: 4.8mm and 3.6mm (p=.02), respectively. The differences were significantly smaller in the smokers (.3) compared to non-smokers (1.3; p=.04) mm. CONCLUSIONS: Records of the entering examination must be considered before turbinoplasty under local anaesthesia.

[Results of inferior nasal turbinate reduction in old and very old patients with chronic rhinitis]. / Ergebnisse der Nasenmuschelverkleinerung bei alten und sehr alten Patienten mit chronischer Rhinitis.

BACKGROUND: Symptoms of chronic rhinitis in old and very old populations may result from isolated hyperplasia of nasal inferior turbinates. Turbinoplasty is a possible method of treatment in these individuals. However, preoperative concerns are associated with their poor general condition: tendency to epistaxis, treatment with anticoagulants, hypertension, and less effective healing. OBJECTIVE: The aim of this study was to determine differences in results of turbinoplasty obtained in old and very old individuals with chronic rhinitis, compared to young and otherwise healthy patients. MATERIAL AND METHODS: We analyzed records of 130 patients with hyperplasia of the inferior turbinates, who had undergone bipolar diathermy turbinoplasty: 82 individuals aged 18-59 (mean = 33.8; SD = 10.2), 30 patients aged 60-74 (mean = 66.0; SD = 3.7) and 18 participants aged 75 + years (mean = 85.3; SD = 6.5). The patients were questioned about the intensity of their symptoms before and one month after the surgery, using the SNOT-20 questionnaire. The duration of wound healing and satisfaction scores were also noted. RESULTS: Nasal patency, nasal discharge and post-nasal drip improved in old and very old patients, similarly as in the young ones. Olfactory and taste function improved significantly more in young individuals. Postoperative healing time was significantly longer in very old patients. CONCLUSIONS: Some results of turbinoplasty in old and very old patients were significantly worse than in young ones.