Surgical Interventions for Inferior Turbinate Hypertrophy: A Comprehensive Review of Current Techniques and Technologies

Abstract

Surgical treatment of the inferior turbinates is required for hypertrophic inferior turbinates refractory to medical treatments. The main goal of surgical reduction of the inferior turbinate is to relieve the obstruction while preserving the function of the turbinate. There have been a variety of surgical techniques described and performed over the years. Irrespective of the techniques and technologies employed, the surgical techniques are classified into two types, the mucosal-sparing and non-mucosal-sparing, based on the preservation of the medial mucosa of the inferior turbinates. Although effective in relieving nasal block, the non-mucosal-sparing techniques have been associated with postoperative complications such as excessive bleeding, crusting, pain, and prolonged recovery period. These complications are avoided in the mucosal-sparing approach, rendering it the preferred option. Although widely performed, there is significant confusion and detachment between current practices and their basic objectives. This conflict may be explained by misperception over the myriad of available surgical techniques and misconception of the rationale in performing the turbinate reduction. A comprehensive review of each surgical intervention is crucial to better define each procedure and improve understanding of the principle and mechanism involved.

Keywords: coblation; cryotherapy; electrocautery; inferior turbinate hypertrophy; laser; microdebrider; radiofrequency; turbinectomy; turbinoplasty.

Figure 1

Nasoendoscopic grading system of inferior turbinate hypertrophy; grade 1 is 0–25% of total airway space occupied (A), grade 2 is 26–50% occupied (B), grade 3 is 51–75% occupied (C), and grade 4 is 76–100% occupied (D).

Figure 2

In conventional turbinoplasty, a freer elevator dissects the turbinate bone and soft erectile tissue (A) and a Blakeley’s forceps later removes part of the soft tissue and bone (B).

Figure 3

Microdebrider blade is placed at the lateral part of the left turbinate to dissect the lateral mucosal wall and turbinate bone from anterior (A) to posterior (B) direction.

Figure 4

Coblation turbinoplasy applied as an intraturbinoplasty technique (A) and extraturbinoplasty technique (B).

Figure 5

Radiofrequency probe is inserted at anterior head of the inferior turbinate and pushed in an anterior (A) to posterior (B) direction.