Turbinates surgery: when and how to perform it / Cirurgia dos cornetos: quando e como realizá-la

RESUMO

In our practice, turbinates became in the last 10 years an important and often used procedure for three basic purposes: (a) for improving nasal patency in chronic nasal obstruction; (b) for improving sinuses ventilation and drainage in chronic or relapsing sinusitis; (c) for relieving rhinogenic craniofacial pains and some neurovascular headhaches. For nasal patency are the important the size of the head and tail of lower turbinates. The tail deserves special attention in children less than five/seven years old and nose blocking not relieved by topic decongestion. The middle turbinate volume and shape plays a minor role in nasal patency but it can be outstanding in determining anterior sinuses ventilation and drainage problems as well as in rhinogeniuc pain and neurovascualr headhaches triggered by abnormnal contacts in middle meatus. Turninates reduction of volume and change in position or shape accomplished through; (a) partial resection (splitting, trimming, localized resection), submucous fractures and/or repositioning (lateralization) of the bony framework; (b) trimming of adequate amount of mucous lining. Reduction of turbinates response to congestive stimuli is achieved through (a) pos-operative submucous cicatrical fibrosis (mainly when submucous comminuted fractures are done); (b) reduction of nerves supply to concomitant avulsion with the mucosal lining resected (mainly from the tail) and - in selected cases - (c) specific submucous coagulation of sphenopalatine glanglion and sphenoplalatine artery nasal branches. Turbinates submucous coagulation is an eventual and complementary procedure for additional improvement of previous surgical results: