Effect of turbinate surgery on mucociliary clearance. A systematic review and metanalysis / Efecto de la cirugía turbinal en el aclaramiento mucociliar. Revisión sistemática y metaanálisis

Despite the fact that turbinate surgery provides satisfactory results regarding nasal obstruction, most of these procedures are destructive, to some extent, for the respiratory epithelium. There are valid hypotheses suggesting either that turbinate surgery may improve mucociliary clearance (MCC) by improving rhinitis, as well hypotheses suggesting that these surgeries may impair it by damaging the nasal ciliated epithelia. This systematic review is designed with the objective of exploring the effect of turbinate surgery on MCC. Pubmed (Medline), the Cochrane Library, EMBASE, SciELO were analyzed. Four authors members of the YO-IFOS rhinology study group independently analyzed the articles. Extracted variables encompassed: sample size, age, indication for surgery, surgical technique, method used to measure mucociliary clearance, mucociliary transport time before and after surgery, and main outcome. 15 studies with a total population of 1936 participants (1618 patients excluding healthy controls) met the inclusion criteria. 9 studies could be combined in a metanalysis, wich revealed a non-statistically significant decrease of 3.86 min in MCTT after turbinate surgery (p = 0.06). The subgroup analysis of the 5 cohorts who underwent microdebrider turbinoplasty reached statistical significance under a random effect model, revealing a 7.02 min decrease in MCTT (p < 0.001). The laser turbinoplasty subgroup, composed of 4 cohorts, also reached significance, although the difference was lower than that for microdebrider turbinoplasty, 1.01 min (p < 0.001). This systematic review and meta-analysis suggests that turbinate surgery does not compromise mucociliary clearance. The available evidence also suggests that turbinate surgery with mucosa sparing techniques improves MCC, while with aggressive techniques it increases or remains the same. ... . (AU)

A pesar de que la cirugía turbinal tiene efectos positivos en la ventilación nasal, gran parte de estos procedimientos son agresivos con el epitelio respiratorio. Existen hipótesis que sugieren que la cirugía turbinal puede mejorar el aclaramiento mucociliar (AMC) al mejorar la rinitis, así como alterarlo al lesional el epitelio nasal. Esta revisión se diseña con el objetivo de explorar el efecto de la cirugía turbinal en el AMC. Se revisó Pubmed (Medline), the Cochrane Library, EMBASE, SciELO. 4 autores miembros de YO-IFOS grupo de estudio en rinología, analizaron de manera independiente los artículos. Las variables analizadas fueron tamaño muestral, edad, indicación quirúrgica, técnica quirúrgica, método de medición de AMC, AMC antes y después de la cirugía y resultado principal. Se incluyeron 15 estudios con 1936 participantes (1618 excluyendo controles sanos). 9 estudios fueron combinados en un metanálisis que demostró una diferencia no estadísticamente significativa de -3,86 minutos en AMC tras cirugía (p = 0,06). El análisis por subgrupos de las 5 cohortes sometidas a turbinoplastia con microdebridador si fueron estadísticamente significativas con una diferencia de -7,02 minutos (p < 0,001). El grupo sometido a laser (4 cohortes) también obtuvo diferencia estadística, aunque menor, -1,01 minutos (p < 0,001). Esta revision y metaanálisis sugiere que la cirugía turbinal no afecta al aclaramiento mucociliar. La evidencia disponible también sugiere que las técnicas menos agresivas con la mucosa mejoran el AMC, mientras que las agresivas podrían aumentarlo o no modificarlo. Este efecto beneficioso se observa desde el 1º al 3º mes postquirúrgico. Sin embargo, para poder obtener adecuadas conclusiones, debe existir un método estandarizado para medir el AMC, así como un método para describir adecuadamente la extensión quirúrgica. (AU)

Effect of turbinate surgery on mucociliary clearance. A systematic review and metanalysis.

Despite the fact that turbinate surgery provides satisfactory results regarding nasal obstruction, most of these procedures are destructive, to some extent, for the respiratory epithelium. There are valid hypotheses suggesting either that turbinate surgery may improve mucociliary clearance (MCC) by improving rhinitis, as well hypotheses suggesting that these surgeries may impair it by damaging the nasal ciliated epithelia. This systematic review is designed with the objective of exploring the effect of turbinate surgery on MCC. Pubmed (Medline), the Cochrane Library, EMBASE, SciELO were analyzed. Four authors members of the YO-IFOS rhinology study group independently analyzed the articles. Extracted variables encompassed: sample size, age, indication for surgery, surgical technique, method used to measure mucociliary clearance, mucociliary transport time before and after surgery, and main outcome. 15 studies with a total population of 1936 participants (1618 patients excluding healthy controls) met the inclusion criteria. 9 studies could be combined in a metanalysis, wich revealed a non-statistically significant decrease of 3.86 min in MCTT after turbinate surgery (p = 0.06). The subgroup analysis of the 5 cohorts who underwent microdebrider turbinoplasty reached statistical significance under a random effect model, revealing a 7.02 min decrease in MCTT (p < 0.001). The laser turbinoplasty subgroup, composed of 4 cohorts, also reached significance, although the difference was lower than that for microdebrider turbinoplasty, 1.01 min (p < 0.001). This systematic review and meta-analysis suggests that turbinate surgery does not compromise mucociliary clearance. The available evidence also suggests that turbinate surgery with mucosa sparing techniques improves MCC, while with aggressive techniques it increases or remains the same. This beneficial effect is evident since the first to third month after surgery. However, for solid conclusions, a standard way to measure MCTT should be stablished, as well as a method to appropriately describe the extension of the surgery.

Turbinate surgery in pediatric patients: A worldwide survey.

OBJECTIVE: Impaired nasal breathing is a common condition among pediatric patients, being rhinitis the most common cause. In recent years, turbinate surgery, mainly turbinate radiofrequency ablation (TRA), has increased in popularity amongst pediatric otolaryngologists and rhinologists as a safe and useful technique to address turbinate hypertrophy in pediatric patients. The present paper is designed with the aim of assessing the current worldwide clinical practice regarding turbinate surgery in pediatric patients. METHODS: The questionnaire was developed based on previous researches, by a group of 12 experts from the rhinology and pediatric otolaryngology research group belonging to the Young Otolaryngologists of the International Federation of Otorhinolaryngological societies (YO-IFOS). The survey was then translated to 7 languages and sent to 25 scientific otolaryngologic societies around the globe. RESULTS: 15 scientific societies agreed to distribute the survey to their members. There were 678 responses from 51 countries. From them, 65% reported to usually perform turbinate surgery in pediatric patients. There was a statistically significant increased likelihood of performing turbinate surgery for those practicing rhinology, sleep medicine, and/or pediatric otolaryngology compared to other subspecialties. The main indication to perform turbinate surgery was nasal obstruction (93.20%); followed by sleep disordered breathing (53.28%), chronic rhinosinusitis (28.70%) and facial growth alterations (22.30%). CONCLUSIONS: There is no general consensus on the indications and ideal technique for turbinate reduction in children. This dissension arises mainly from the lack of scientific evidence. The points with highest agreement (>75%) between respondents is the use of nasal steroids prior to surgery; reintroducing nasal steroids in allergic patients; and performing turbinate surgery as day-case surgery.

Turbinate surgery in pediatric patients: A worldwide survey / Cirugía de cornetes en población pediátrica: una encuesta global

Objective: Impaired nasal breathing is a common condition among pediatric patients, being rhinitis the most common cause. In recent years, turbinate surgery, mainly turbinate radiofrequency ablation (TRA), has increased in popularity amongst pediatric otolaryngologists and rhinologists as a safe and useful technique to address turbinate hypertrophy in pediatric patients. The present paper is designed with the aim of assessing the current worldwide clinical practice regarding turbinate surgery in pediatric patients.MethodsThe questionnaire was developed based on previous researches, by a group of 12 experts from the rhinology and pediatric otolaryngology research group belonging to the Young Otolaryngologists of the International Federation of Otorhinolaryngological societies (YO-IFOS). The survey was then translated to 7 languages and sent to 25 scientific otolaryngologic societies around the globe.Results15 scientific societies agreed to distribute the survey to their members. There were 678 responses from 51 countries. From them, 65% reported to usually perform turbinate surgery in pediatric patients. There was a statistically significant increased likelihood of performing turbinate surgery for those practicing rhinology, sleep medicine, and/or pediatric otolaryngology compared to other subspecialties. The main indication to perform turbinate surgery was nasal obstruction (93.20%); followed by sleep disordered breathing (53.28%), chronic rhinosinusitis (28.70%) and facial growth alterations (22.30%). (AU)

Objetivo: La obstrucción nasal es una enfermedad habitual en pacientes pediátricos, siendo la rinitis la causa más frecuente. En los últimos años la cirugía de cornetes, especialmente la radiofrecuencia (RF), ha aumentado su popularidad entre los otorrinolaringólogos pediátricos y los rinólogos como una técnica segura y eficaz para tratar esta enfermedad en población pediátrica. Este artículo se diseña con el objetivo de evaluar la práctica clínica habitual a este respecto a nivel global.MétodosEl cuestionario fue diseñado basado en trabajos previos por un grupo de 12 expertos del Grupo de Investigación en Rinología y en Otorrinolaringología Pediátrica de la Young Otolaryngologists of the International Federation of Otorhinolaryngological societies (YO-IFOS). La encuesta fue traducida a 7 idiomas y enviada a 25 sociedades científicas.ResultadosQuince sociedades científicas aceptaron distribuir la encuesta entre sus miembros. Hubo 678 respuestas de 51 países. De ellos, el 65% comunicó realizar de manera habitual cirugía de cornetes en población pediátrica. Se observó una mayor probabilidad de realizar la intervención entre especialistas en Rinología, Medicina del sueño u Otorrinolaringología pediátrica comparado con el resto de las subespecialidades. La indicación más habitual para realizar la cirugía fue obstrucción nasal (93,20%), seguida por trastorno respiratorio del sueño (53,28%), rinosinusitis crónica (28,70%) y alteraciones del desarrollo facial (22,30%). (AU)

Cirugía de cornetes inferiores en población pediátrica: ¿Cómo, cuándo y por qué? / Inferior turbinate surgery in pediatric population: How, when and why?

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.

Quilting sutures compared with sponge packing in septolplasty and turbinoplasty.

INTRODUCTION: There is a lack of consensus regarding the need for nasal packing after a septoplasty. The use of nasal packing has been proposed to reduce bleeding, synechiae and haematomas. Despite these advantages evidence is scant to support postoperative packing. Furthermore, packing is not an innocuous procedure and can cause complications. OBJECTIVE: The purpose of this study was to investigate the efficacy of quilting sutures compared with sponge nasal packing on haemostasis, haematomas and wound healing following septoplasty. MATERIAL AND METHODS: Seventy-six patients with nasal septum deviation requiring septoplasty and turbinoplasy with radiofrequency were included. Following surgery, fifty patients were selected randomly for septoplasty with one quilting suture. And twenty-six patients had sponge nasal packing. Haemostatic properties, formation of haematomas, formation of synechiae, the patients' pain and bleeding on removal of the packing were evaluated. RESULTS: Both techniques were equally effective in the control of postoperative bleeding, haematoma and synechiae formation following septoplasty. Sponge packing was associated with significant pain and bleeding on removal. CONCLUSION: The use of quilting sutures like sponge packing is efficient in controlling bleeding, synechiae and haematomas after septoplasty and turbinoplasty.

Comparación entre una sutura transfixiante y el taponamiento nasal en la septoplastia y turbinoplastia / Quilting sutures compared with sponge packing in septolplasty and turbinoplasty

Introducción: No existe un consenso sobre la necesidad del taponamiento nasal después de una septoplastia. El uso de los taponamientos ha sido propuesto con el fin de reducir las hemorragias, sinequias o hematomas después de este procedimiento. A pesar de estas ventajas la evidencia del uso de un taponamiento nasal es baja. Adicionalmente este procedimiento no es agradable para el paciente y puede tener complicaciones.ObjetivoEl propósito de este estudio es investigar la eficacia de la sutura transfixiante o transeptal comparada con el taponamiento nasal. Analizar el control de la epistaxis, hematomas y sinequias después de una septoplastia.Material y métodosSetenta y seis pacientes con indicación de septoplastia y turbinoplastia con radiofrecuencia fueron incluidos en el estudio. Pseudoaleatoriamente se utilizó una sutura transfixiante en 50 pacientes y taponamiento nasal en 26 pacientes después de la cirugía. En los 2 grupos se comparó el porcentaje de epistaxis, hematomas y sinequias. Además, el dolor y la epistaxis de los pacientes al retirar el taponamiento nasal.ResultadosTanto la sutura transfixiante como el taponamiento nasal tienen resultados similares en cuanto al control de las epistaxis, sinequias y hematomas después de la septoplastia con radiofrecuencia de cornetes. Los pacientes con taponamiento nasal presentaron dolor y epistaxis autolimitada en el momento de retirar el taponamiento nasal.ConclusiónEl uso de la sutura transfixiante después de una septoplastia y turbinoplastia con radiofrecuencia es igual de eficaz que el taponamiento nasal para el control de epistaxis, sinequias y hematomas. (AU)

Introduction: There is a lack of consensus regarding the need for nasal packing after a septoplasty. The use of nasal packing has been proposed to reduce bleeding, synechiae and haematomas. Despite these advantages evidence is scant to support postoperative packing. Furthermore, packing is not an innocuous procedure and can cause complications.ObjectiveThe purpose of this study was to investigate the efficacy of quilting sutures compared with sponge nasal packing on haemostasis, haematomas and wound healing following septoplasty.Material and methodsSeventy-six patients with nasal septum deviation requiring septoplasty and turbinoplasy with radiofrequency were included. Following surgery, fifty patients were selected randomly for septoplasty with one quilting suture. And twenty-six patients had sponge nasal packing. Haemostatic properties, formation of haematomas, formation of synechiae, the patients’ pain and bleeding on removal of the packing were evaluated.ResultsBoth techniques were equally effective in the control of postoperative bleeding, haematoma and synechiae formation following septoplasty. Sponge packing was associated with significant pain and bleeding on removal.ConclusionThe use of quilting sutures like sponge packing is efficient in controlling bleeding, synechiae and haematomas after septoplasty and turbinoplasty. (AU)

Quilting sutures compared with sponge packing in septolplasty and turbinoplasty. / Comparación entre una sutura transfixiante y el taponamiento nasal en la septoplastia y turbinoplastia.

INTRODUCTION: There is a lack of consensus regarding the need for nasal packing after a septoplasty. The use of nasal packing has been proposed to reduce bleeding, synechiae and haematomas. Despite these advantages evidence is scant to support postoperative packing. Furthermore, packing is not an innocuous procedure and can cause complications. OBJECTIVE: The purpose of this study was to investigate the efficacy of quilting sutures compared with sponge nasal packing on haemostasis, haematomas and wound healing following septoplasty. MATERIAL AND METHODS: Seventy-six patients with nasal septum deviation requiring septoplasty and turbinoplasy with radiofrequency were included. Following surgery, fifty patients were selected randomly for septoplasty with one quilting suture. And twenty-six patients had sponge nasal packing. Haemostatic properties, formation of haematomas, formation of synechiae, the patients' pain and bleeding on removal of the packing were evaluated. RESULTS: Both techniques were equally effective in the control of postoperative bleeding, haematoma and synechiae formation following septoplasty. Sponge packing was associated with significant pain and bleeding on removal. CONCLUSION: The use of quilting sutures like sponge packing is efficient in controlling bleeding, synechiae and haematomas after septoplasty and turbinoplasty.

Rinoplastía y rinoseptoplastía funcional: mejorando la función nasal más allá de la cirugía del tabique y los cornetes nasales / Functional rhinoplasty and septorhinoplasty: improving nasal function beyond septal and turbinate surgery

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.

Hipertrofia de cornetes inferiores: revisión sobre técnicas quirúrgicas actuales / Inferior turbinate hypertrophy: review of current surgical techniques

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.

Effects of turbinoplasty versus outfracture and bipolar cautery on the compensatory inferior turbinate hypertrophy in septoplasty patients / Efeitos da turbinoplastia versus fratura lateral e cauterização bipolar no volume da concha inferior hipertrófica compensatória em pacientes submetidos a septoplastia

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.

Effects of turbinoplasty versus outfracture and bipolar cautery on the compensatory inferior turbinate hypertrophy in septoplasty patients.

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.

Virtual surgery for patients with nasal obstruction: Use of computational fluid dynamics (MeComLand®, Digbody® & Noseland®) to document objective flow parameters and optimise surgical results. / Cirugía virtual para pacientes con obstrucción nasal: empleo de un software basado en dinámica de fluidos (MeComLand®, Digbody® & Noseland®) para documentar parámetros objetivos de flujo y optimizar resultados quirúrgicos.

INTRODUCTION: Computational fluid dynamics (CFD) is a mathematical tool to analyse airflow. We present a novel CFD software package to improve results following nasal surgery for obstruction. METHODS: A group of engineers in collaboration with otolaryngologists have developed a very intuitive CFD software package called MeComLand®, which uses the patient's cross-sectional (tomographic) images, thus showing in detail results originated by CFD such as airflow distributions, velocity profiles, pressure, or wall shear stress. NOSELAND® helps medical evaluation with dynamic reports by using a 3D endoscopic view. Using this CFD-based software a patient underwent virtual surgery (septoplasty, turbinoplasty, spreader grafts, lateral crural J-flap and combinations) to choose the best improvement in nasal flow. OBJECTIVE: To present a novel software package to improve nasal surgery results. To apply the software on CT slices from a patient affected by septal deviation. To evaluate several surgical procedures (septoplasty, turbinectomy, spreader-grafts, J-flap and combination among them) to find the best alternative with less morbidity. RESULTS: The combination of all the procedures does not provide the best nasal flow improvement. Septoplasty plus turbinoplasty obtained the best results. Turbinoplasty alone rendered almost similar results to septoplasty in our simulation. CONCLUSIONS: CFD provides useful complementary information to cover diagnosis, prognosis, and follow-up of nasal pathologies based on quantitative magnitudes linked to fluid flow. MeComLand®, DigBody® and NoseLand® represent a non-invasive, low-cost alternative for the functional study of patients with nasal obstruction.

Assessment of nasal obstruction with rhinomanometry and subjective scales and outcomes of surgical and medical treatment. / Evaluación de la obstrucción nasal mediante rinomanometría y escalas subjetivas y medición del éxito terapéutico médico y quirúrgico.

INTRODUCTION: Prospective study of patients with nasal obstruction (NO) in order to measure therapeutic success by anterior active rhinomanometry (AAR), Nasal Obstruction Symptom Evaluation (NOSE) scale and Visual Analogue Scale (VAS) and to establish the correlation between these tests. METHODS: Patients with NO, on whom we performed an AAR, NOSE and VAS scales at baseline and after medical treatment (topical nasal steroid) or surgery (septoplasty, turbinoplasty or septoplasty and turbinoplasty). The nasal flow obtained by the AAR and the score of both subjective scales (NOSE and VAS) were compared and analyzed. RESULTS: A total of 102 patients were included in the study. Surgical treatment resulted in statistically significant differences with the AAR and the subjective scales. While in patients with medical treatment there was an increase in the AAR nasal flow but without statistical significance (P=.1363). The correlation between the AAR, the NOSE and VAS scales was measured finding a strong correlation between the NOSE and VAS scales only (r=.83327). CONCLUSIONS: The patients with NO treated surgically have better results when these are evaluated by AAR or with subjective scales. There is no significant correlation between AAR, NOSE and VAS scales, this is considered to be because the AAR and subjective scales are complementary and measure different aspects of NO. The AAR and subjective scales are useful tools to be used together for the follow up of patients with NO.

Turbinoplastia endoscópica del cornete inferior para el tratamiento de la rinitis crónica hipertrófica no infecciosa: serie de casos / Endoscopic turbinoplasty of the inferior turbinate for the treatment of non-infectious chronic hypertrophic rhinitis: case series

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 porciento eran masculinos; el 69,4 porciento presentó rinitis alérgica. Predominó la obstrucción nasal asociada a rinorrea, prurito y cefalea (44,4 porciento), así como la hipertrofia grado II (58,3 porciento). Después de la cirugía todos los pacientes mejoraron y solo el 8,3 porciento 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(AU)

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 patients were followed for 6 months. Results: 36 patients were included, 63.9 percent were male; 69.4 percent had allergic rhinitis. Nasal obstruction associated with rhinorrhea, pruritus and headache (44.4 percent) and grade II hypertrophy (58.3 percent) predominated. After surgery all patients improved and only 8.3 percent 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(AU)

Turbinoplastia endoscópica del cornete inferior para el tratamiento de la rinitis crónica hipertrófica no infecciosa: serie de casos / Endoscopic turbinoplasty of the inferior turbinate for the treatment of non-infectious chronic hypertrophic rhinitis: case series

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.