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PubMedDate not supplied

Comparative study of the effects of submucosal cauterization of the inferior turbinate with or without outfracture.

AIM: The objective of this study was to compare the effects of submucosal cauterization of the inferior turbinate with or without outfracture. STUDY DESIGN: Clinical prospective. METHOD: Twenty patients with inferior turbinate hypertrophy were randomized and divided into two groups. The first one was submitted to submucosal cauterization associated with outfracture, and the second one without fracture. Five items were assessed to compare both methods: pain, nasal bleeding, scarring--analyzed through anterior rhinoscopy, observing edema, hyperemia and seropurulent secretion; crust formation (seen through anterior rhinoscopy); and nasal airway patency. Follow-up was performed on days 7, 14, 30. RESULTS: In both groups crusting formation was similar. Scarring showed better results in the outfracture group in the first two weeks postoperative. The analysis of nasal airway patency showed good results in 80% of the patients submitted to submucosal cauterization with outfratcture on day 30 postoperatively. CONCLUSIONS: We concluded that submucosal cauterization of inferior turbinate with outfracture is better than the procedure without outfracture.

Adolescent↗
PubMed1993

Mast cell quantitation in nasal polyps, sinus mucosa and nasal turbinate mucosa.

The distribution and abundance of mast cells in nasal polyps, the maxillary sinus mucosa of patients with sinusitis and the turbinate mucosa of allergic rhinitis was microscopically examined using different methods of fixation. In the epithelium of the surface and the ducts of nasal polyps (n = 8), the mean number of mast cells was over 20,000 per mm3 using Mota's fixation and the increase was correlated with the epithelial thickness (P < 0.05). On the other hand those of the maxillary sinus mucosa (n = 6) and the nasal turbinate mucosa (n = 7) were less than 6,000 per mm3. In the subepithelial layer or areas deeper than the area with the glands, however, mast cell counts were less than 3,200 per mm3 in all diseases. More than 70-90 per cent of all mast cells in the epithelium of the mucosal surface and the ducts of the polyp, the maxillary sinus mucosa and nasal turbinates were formalin sensitive. Most of the mast cells in the subepithelial and deeper areas were formalin resistant in all diseases. These results suggest that conditions for mast cell growth differ between polyps and the other diseases, and that the conditions which affect mast cells may contribute to polyp development.

Adolescent↗
PubMed1993

Inferior turbinate resection: the need for a nasal pack.

A random prospective study of 180 patients with chronic nasal obstruction who underwent inferior turbinate resection as a part of a multinasal surgical procedure is presented. The aim of our study was to examine the influence of nasal pack on the incidence of post-operative haemorrhage following inferior turbinate resection. The haemorrhage rate in Group 1 (no nasal pack), Group 2 (nasal pack retained for 24 hours) and Group 3 (nasal pack retained for 48 hours) was 11.7, 8.3 and 0 per cent respectively. We recommend that a nasal pack should be retained for 48 hours following inferior turbinate resection.

Adolescent↗
PubMed2000

Involvement of inferior turbinate mucosa in chronic sinusitis--localization of T-cell subset.

BACKGROUND: In chronic sinusitis (CS), different subsets of leukocytes are involved in development of persistent inflammation of the nasal mucosa. The localization and differentiation of these infiltrating lymphocytes may help us to understand the inflammatory interactions in the epithelium, lamina propria, and seromucous glands of the nasal mucosa in CS. METHODS: We examined frozen sections of inferior turbinates from 14 patients with nonallergic CS and 10 normal nonallergic controls. We used the avidin-biotin-peroxidase (ABC) technique with monoclonal antibodies against CD3 (total T cells), CD4 (T-helper/inducer cells), CD8 (T-suppressor/cytotoxic cells), CD22 (B cells), CD56 (natural killer cells), elastase (neutrophil granulocytes), eosinophil cationic protein (eosinophil granulocytes), and CD68 (macrophages). RESULTS: We found significant increases (P < 0.05) of CD3, CD4, and CD8 T cells and B cells in the nasal mucosa of patients with CS. The number of CD68 cells and eosinophils showed no significant rise. CONCLUSIONS: The different types of leukocytes play a key role in the defense of the respiratory tract. The analysis of the distribution of cells in the epithelium, mucosa, and glands of the inferior turbinate confirmed that nonallergic CS is, in fact, chronic, bacterial rhinosinusitis involving the inferior turbinates, and that the pathomechanism is therefore different from that of nasal polyposis.

Adolescent↗
PubMed2000

A randomised clinical trial of turbinectomy for compensatory turbinate hypertrophy in patients with anterior septal deviations.

Turbinectomy is performed at the time of nasal septal surgery by many otolaryngologists. One reason given for this procedure is the presence of a hypertrophied contralateral inferior turbinate. A randomised trial was undertaken to evaluate the relief of nasal obstruction following contralateral turbinectomy with septal surgery. Patients presenting with nasal obstruction who had a unilateral septal deviation and contralateral inferior turbinate enlargement were prospectively randomized to contralateral turbinectomy or no turbinate surgery at the time of septal surgery. Questionnaires and active anterior rhinomanometry were used for evaluation. Twenty-six patients (mean age 31 years) demonstrated a reduction in subjective and objective measures of nasal obstruction (P < 0.05) 8 weeks after operation. There was no intergroup difference, the median total decongested nasal resistance postoperatively in the non-turbinectomized patients was 0.17 kPal-1 s and 0.21 kPal-1 s in the turbinectomized patients. Contralateral inferior turbinectomy does not add to the relief of nasal obstruction beyond that attained by septal surgery in these patients.

Adolescent↗
PubMed2001

The effect of inferior turbinate hypertrophy on nasal spray distribution to the middle meatus.

The distribution of topical nasal sprays is suboptimal, the main obstruction to adequate delivery in normal volunteers being the nasal valve. We aimed to test the hypothesis that, in patients with rhino-sinusitis, hypertrophy of the inferior turbinate also limits the distribution of administered drug to the middle meatus. We modelled the effect of inferior turbinate hypertrophy and reduction by effecting congestion (by ipsilateral isometric exercise) and decongestion (topical oxymetazoline) in normal volunteers. The method chosen to estimate drug delivery to the middle meatus used endoscopic photography after the administration of dyed aqueous spray. A randomized cross-over study design was used and 20 nasal cavities were studied. The congestion/decongestion manoeuvres significantly altered nasal airflow, as measured by peak inspiratory nasal flow (P < 0.001). Congestion diminished significantly drug delivery to the middle meatus, as compared with decongestion (P = 0.026). This may support a clinical role for inferior turbinate reduction to improve the efficacy of topical nasal therapy, as well as improving nasal airflow.

Administration, Intranasal↗
PubMed2000

Light and scanning electron microscopic studies of the nasal turbinates of the horse.

The nasal turbinates of 5 young horses were studied by light and scanning electron-microscopy. Stratified cuboidal epithelium lined the rostral part of the dorsal and ventral nasal turbinates of the vestibular region. The polyangular microvillus cells of this region were separated by linear depressions. The mid and caudal parts of the dorsal and ventral nasal turbinates and the rostral part of the ethmoturbinates were lined by pseudostratified columnar ciliated respiratory epithelium. Numerous cilia with dilated blebs on the ciliated cells concealed adjacent non-ciliated supporting cells and goblet cells. The olfactory zone consisting of the olfactory vesicle and a dense network of olfactory cilia localized to the caudal part of the ethmoturbinates. The three regions were delineated from each other by transitional zones.

Animals↗
PubMed2002

[Ho:YAG and diode laser treatment of hyperplastic inferior nasal turbinates].

BACKGROUND: Since the early 80's, chronic nasal obstruction due to hyperplastic turbinates is treated by laser light. Comparative clinical studies were performed to assess the clinical outcome of laser assisted endonasal turbinate surgery in longterm. METHODS: By means of a pulsed Ho:YAG laser emitting light at lambda = 2100 nm (0.8 - 1.2 J/pulse, 4 - 8 Hz), 69 patients suffering from nasal obstruction due to allergic rhinitis (46 %) and vasomotor rhinitis (54 %) were treated under local anesthesia. Furthermore, 50 patients (52 % with allergic rhinitis and 48 % with vasomotor rhinitis) were treated by means of a GaAlAs-diode laser (c. w., lambda = 940 nm, 8 - 10 W). The treatment time took 3 - 10 min/turbinate and nasal packing was not necessary after the laser procedure. The study was conducted by a standardized questionnaire, photo documentation, allergy test, mucociliar function test, rhinomanometry, and acoustic rhinometry. RESULTS: Within 4 weeks after laser treatment, an improvement of nasal airflow correlating to the extent of the ablated turbinate tissue could be determined in more than 80 % of the patients. Rhinomanometry revealed a significant improvement of the nasal airflow 6 months and 1 year after the laser treatment compared to the preoperative data. Side effects like nasal dryness and pain were rare (< 5 %). Diode laser treatment revealed more effective results than Ho:YAG laser treatment, however there was no significant difference between the two investigated groups. Patients suffering from vasomotor rhinitis showed far better results in long term in comparison to allergic rhinitis patients. CONCLUSIONS: Ho:YAG and diode laser treatment can be performed as an outpatient procedure under local anesthesia in a short treatment time with promising results. It could become a time and cost effective treatment modality in endonasal laser surgery.

Adult↗
PubMed2003

Sellar floor reconstruction with nasal turbinate tissue after endoscopic endonasal transsphenoidal surgery for pituitary adenomas.

BACKGROUND: The emerging endoscopic endonasal transsphenoidal approach for pituitary adenomas is safe and effective. An intraoperative sellar floor reconstructive method after this approach is challenging.[nl] OBJECTIVE: To describe a simple method of sellar reconstruction after endoscopic endonasal transsphenoidal surgery for pituitary adenomas by nasal turbinate tissue.[nl] MATERIALS AND METHODS: Thirty patients with defects in the floor of the sella turcica, after endoscopic endonasal transsphenoidal surgery for pituitary adenomas, underwent reconstruction with nasal turbinate tissue. The surgical technique is described.[nl] RESULTS: Patients who underwent this sellar reconstruction did not show postoperative cerebrospinal leak or other complications.[nl] CONCLUSION: Nasal turbinate tissue is an excellent source of donor material for successful reconstruction of the sellar floor. It is costless, safe, soft, malleable and easy to obtain in the same field of surgery with suitable size without inducing side effects or complications.

Adenoma↗
PubMed1999

[Nd:YAG laser treatment of the lower turbinates with contact in hyperreflexic and allergic rhinopathy].

BACKGROUND: Nasal obstruction caused by mucosal swelling due to hyperreflectory or allergic rhinitis is a very frequent disorder. We would like to report about our first results (ENT department, University of Göttingen) in the reduction of hyperplastic inferior turbinates by Nd:YAG Laser treatment. PATIENTS AND METHOD: One hundred seventeen patients with nasal obstruction were treated by Nd:YAG laser between October 1993 and February 1997. We used the laser in "contact mode" and all outpatients were under local anaesthesia. Follow-up was possible in 83 cases. A subjective scale was used to evaluate our results. One quarter of the patients suffered from an allergic rhinitis. RESULTS: For 80% the nasal airflow was increased. Sixty percent had excellent or good results without any nasal obstruction after therapy. The patients with allergic rhinitis performed as well as the patients with hyperreflectory rhinopathy. This improvement appeared as early as four weeks after treatment and was permanent in 37 of 40 cases with long-term observation of at least one year. Side effects: 14% reported a dry nasal mucosa for two weeks; 31% had a bloody nasal secretion for two days after treatment, but did not bleed. Fifteen percent complained of pain during the procedure. CONCLUSION: The reduction of the inferior turbinates by Nd:YAG laser is an effective treatment of equal value in symptomatic therapy of the hyperplastic turbinates due to hyperreflectory and allergic rhinopathy. Seventy-three percent of these patients would like to be treated in this way again if necessary.

Adolescent↗
PubMed1993

[Model studies of nasal turbinate surgery].

The improvement of nasal air flow often requires, in addition to septoplasty, surgery of the turbinates. In order to broaden our knowledge of the influence of turbinate surgery on nasal function, the authors investigated nasal models with different lateral walls by visualisation of flow patterns and rhinoresistometry. Anterior turbinoplasty and turbinectomy reduce the nasal resistance to air flow, but the respiratory function of the nose deteriorates. As the result of these experiments, a trimming of hyperplastic turbinates must create a normal shape of lateral nasal wall, because the respiratory function is based on nearly regular narrow cavities.

Biomechanical Phenomena↗
PubMed1991

[Possibilities of treating nasal turbinates in the framework of endonasal microsurgery].

Pathologic alterations of the turbinates are common in infectious diseases of the nose and paranasal sinuses. Over 300 patients were treated for paranasal sinuses disease from 1986 to 1989 by endonasal microsurgery. One-third of the patients were found intraoperatively to have alterations of the middle and inferior turbinate causing obstruction and functional disorders of the nose and sinuses. Our concept comprises a step-by-step microsurgical approach to the turbinates. The technique and the results are presented.

Airway Obstruction↗
PubMed2000

Middle turbinate medialization and preservation in endoscopic sinus surgery.

OBJECTIVE/HYPOTHESIS: Lateral synechia formation between the middle turbinate (MT) and the lateral nasal wall is the most common complication of endoscopic sinus surgery. In an attempt to prevent this complication, a simple technique to preserve and medialize the MT was studied. METHODS: Five hundred patients underwent endoscopic sinus surgery with MT medialization and preservation. The caudal end of the MT and the opposing septal mucosa were abraded with a microdebrider for controlled synechia formation in an attempt to avoid lateralization of the MT. Follow-up ranged from 6 to 18 months, with a mean follow-up of 10 months. RESULTS: Ninety-three percent of the patients had successful MT medialization with a well-defined synechia between the septum and the MT. CONCLUSIONS: MT medialization with a microdebrider is simple, is reliable, and should be considered an alternative to turbinate resection or to other turbinate medialization techniques.

Adult↗
PubMed2005

Reconstituting middle turbinate anatomy after pituitary surgery.

Pituitary surgery is now increasingly performed as a joint procedure combining the expertise of a neurosurgeon and an otorhinolaryngologist. As endoscopic sinus surgery is currently one of the commonest surgical procedures performed by ear, nose and throat surgeons, familiarity of sphenoid sinus anatomy over several years of training becomes second nature to those with this interest. The endoscopic approach to the pituitary fossa via the sphenoid sinus allows a minimally invasive approach, thus reducing postsurgical morbidity and duration of hospital stay. The surgical approach involves lateralization of the middle turbinate followed by burring away of the face of the sphenoid air cell. Those without experience of sinus surgery may neglect to reconstitute the position of the middle turbinate at completion of surgery. Further mucosal contraction, scarring and synechiae formation will cause spontaneous lateralization of the middle turbinate during the healing period. This may predispose the patient to chronic sinusitis as a consequence of occlusion at the critical osteomeatal complex. The most satisfactory postoperative results are achieved by maintaining patency of the middle meatus. This will allow sinus aeration and drainage, and the delivery of topical medication should this be required. This paper describes a conchopexy suture placed at completion of pituitary fossa surgery. A carefully placed suture will maintain a widely patent middle meatus during the phase of postoperative healing, thus reducing the risk of chronic sinusitis.

Endoscopy↗
PubMed1996

Pneumatized superior turbinate as a cause of referred migraine headache.

Three patients with typical (common) migraine unresponsive to conventional therapy were evaluated with complete otolaryngologic examination, diagnostic nasal endoscopy, and coronal sinus computed tomography (CT). Enlargement of the superior turbinate due to pneumatization, with accompanying mucosal contact, was found in each case. Application of topical or injected anesthetic to the superior turbinate lessened or relieved headache, and subsequent endoscopic sinonasal surgery succeeded in providing significant headache relief (follow-up of 6 to 14 months). This is the first report of superior turbinate variations/abnormalities causing migraine, or indeed any type of headache. A discussion of the mechanism of referred pain from mucosal contact is offered after a discussion of each case.

Adolescent↗
PubMed1999

Ho:YAG laser treatment of hyperplastic inferior nasal turbinates.

OBJECTIVES: Although preliminary studies about the successful use of the Ho:YAG laser in nasal turbinate surgery have been reported, no clinical study has been performed on this procedure. The aim of this prospective clinical study was to assess the long-term effect of Ho:YAG laser in the treatment of hyperplastic inferior nasal turbinates. METHODS: Eighty-five patients with nasal obstruction who did not respond to conservative medical treatment were treated with a pulsed Ho:YAG laser (wavelength of =2080 nm). Fifty-two of these patients were included in this clinical study and were followed for 1 year. RESULTS: Within the first 2 weeks, nasal obstruction was correlated to the extent of nasal crusting. Six months after laser treatment, the mucociliary function test showed no variation compared with the preoperative measurements. One year after laser treatment 77% of the patients demonstrated improved nasal airflow on rhinomanometry and questionnaire. CONCLUSIONS: Ho:YAG-laser treatment of hyperplastic turbinates can be performed as outpatient surgery under local anesthesia and offers controllable ablation of soft tissue in a short operation time with satisfactory results and excellent patient acceptance.

Feasibility Studies↗
PubMed2000

Role of middle turbinate biopsy in the diagnosis of fulminant invasive fungal rhinosinusitis.

OBJECTIVE: To determine the efficacy of middle turbinate biopsy in the diagnosis of fulminant invasive fungal rhinosinusitis. STUDY DESIGN: Nonrandomized prospective study. METHODS: Directed middle turbinate biopsy was performed in 25 patients suspected of having fulminant invasive fungal rhinosinusitis. All patients were immunocompromised and had fever of unknown origin, symptoms of rhinosinusitis, or both. RESULTS: Six patients were found to have fungal invasion on histopathological review (6 true-positive findings), disease developed in 2 patients with negative results on biopsy (2 false-negative findings), and disease never developed in 17 patients with negative results on biopsy (17 true-negative findings), resulting in an overall sensitivity of 75% and a specificity of 100%. CONCLUSIONS: Middle turbinate biopsy is a safe and effective method of making a timely diagnosis of fulminant invasive fungal rhinosinusitis. The added morbidity and cost of surgery can be avoided in the patient with a negative finding on biopsy. However, the effect of earlier diagnosis on overall patient survival is unclear at present.

Adult↗
PubMed2002

Impact of unilateral sinus surgery with resection of the turbinates by means of midfacial degloving on nasal air conditioning.

OBJECTIVE/HYPOTHESIS: One of the most important functions of the nose is the climatization of inspired air. The aim of the investigation was to determine the influence of radical sinus surgery with complete resection of the turbinates and the lateral nasal wall by means of midfacial degloving as treatment for inverted papilloma on the nasal humidification and heating of inspired air. STUDY DESIGN: Retrospective study. METHODS: Humidity and temperature were measured in the nasopharynx during normal respiration by means of a miniaturized thermocouple device and a humidity sensor for continuous detection. Eight patients after prior unilateral sinus surgery by means of midfacial degloving for a one-sided inverted papilloma were enrolled into the study. The humidity and temperature data of the surgically treated side were compared to the values of the healthy side that was not surgically treated. Active anterior rhinomanometry and acoustic rhinometry were performed. RESULTS: At the end of inspiration, absolute humidity and temperature values in the nasopharynx were statistically significantly lower on the surgically treated side compared with the side that was not surgically treated. CONCLUSIONS: Radical sinus surgery with resection of the turbinates by means of midfacial degloving seems to disturb the climatization of the inspiratory air in the nasal cavity. Reduced absolute humidity and temperature may contribute to crusting, bleeding, and nasal dryness as frequent complaints of patients after aggressive sinus surgery with resection of the turbinates.

Adult↗