I recently had a CAT scan which was reviewed by my otolaryngologist. He
indicated that I need to have a turbinoplasty operation. He said this would
involve removing a set of my turbinates. I asked him about complications, and
he said that although the air would be dryer entering the nose, since I live
in Tennessee this should not present a problem. He also does laser surgery,
however, he felt that I should have my turbinates removed. I am worried about
developing headaches from the dry air. If I did have the turbinates reduced
via a laser would the scar tissue eliminate their humidifying ability anyway?
Please give your advice as to how you would procede at this point. Thank
you.
Reply: ---------------------
Whether or not any turbinate surgery is indicated is dependent upon one's symptoms, medical evaluation including physical exam and tests, as well as the results of medical therapy. You did not mention the type of symptoms you were experiencing nor what non-surgical treatments you have tried.
Turbinate surgery is generally recommended for individuals who have obstruction to the flow of air through the nose, in whom a medical evaluation has determined that the turbinates are the primary source of the problem, and in whom sustained non-surgical treatment measures have failed. Sustained medical treatment implies that environmental factors have been addressed or eliminated; decongestants have not been helpful or could not be used because of side effects or other medical conditions; nasal steroid sprays have been tried continuously over several weeks and were ineffective, amongst other measures.
Few otolaryngologic surgeons advocate total turbinate removal. The turbinates do have some purpose and that is to warm and humidify the air that is inspired through the nose which results in improved efficiency of respiration. However, when turbinates significantly obstruct the nasal passages and non-surgical measures fail, turbinate surgery is often recommended. Rather than total turbinectomy, partial turbinectomy, turbinoplasty, or laser assisted reduction of the turbinates is usually recommended in this case in an attempt to improve nasal airflow without completely removing the turbinates.
The type of surgery performed is usually determined by the surgeon's experience and preference. Partial turbinectomy, turbinoplasty, or laser assisted turbinate reduction all have similar potential for successful elimination of symptoms as well as similar risks. The main risks of such surgeries include excessive bleeding, or infection in the short term. Long term risks include the development of atrophic rhinitis related to over-resection or over-reduction of the turbinates. Atrophic rhinitis may be associated with dry nasal mucous membranes, crusting, foul nasal discharge, discomfort, etc. Again, the risk of atrophic rhinitis is related to excessive removal of turbinate tissue and in the hands of experienced ENT surgeons, this risk should be remote.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
NOTICE: OFCN is not engaged in the rendering of professional medical services. The information contained on this system or any other OFCN system should not supplant individual professional consultation. It is offered exclusively as a community education service. Advice on individual problems must be obtained directly from a professional.
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