[Bacterial content of the turbine spray. II. Built-in turbines].
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Aerosols↗
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[Development of new type plastics air turbine handpiece for dental use].
The noise generated by the metal air turbine handpiece employed in dental practice is considerable and attended with predominant high frequency components. Therefore, investigation of the noise generation mechanism and development of a silent air turbine handpiece was only a matter of course. In addition, the metal air turbine hardpiece is comparatively heavy and its production cost is high. From this point of view as well, production of a light air turbine handpiece at low cost is also desirable. In order to overcome the objections to the metal air turbine handpiece, appropriate plastics materials were employed wherever possible. In this study, the number of revolutions, noise level, frequency analysis, start pressure and weight of newly produced plastics handpieces and metal handpieces were examined and compared. The following results were obtained: 1. The number of revolutions of single-nozzle type air turbine handpieces encased in plastics housings and fitted with metal turbine rotors was higher than that of all-metal air turbine handpieces. The noise level of the former tended to be lower. 2. The number of revolutions of multi-nozzle type air turbine handpieces encased in plastics housings and fitted with turbine rotors with plastics turbine blades was almost equal to that of similar metal handpieces, with the noise level tending to be lower. 3. In the case of handpieces fitted with turbine rotors with dynamic balance, the number of revolutions was high and the noise level was low. This indicated that dynamic balance was a factor affecting the number of revolutions and noise level. 4. Narrow band sound frequency analysis of single-nozzle type air turbine handpieces showed a sharp peak at the fundamental frequency which was the same as the number of revolutions multiplied by the number of rotor turbine blades. It is thought that the noise from air turbine handpieces was aerodynamic in origin, being generated by the periodical interruption of steady air flow by rotor turbine blades. 5. The start pressure of plastics handpieces was almost equal to that of metal handpieces. 6. The weight of plastics handpieces was 20%-50% of that of metal handpieces. The present results indicate that it is possible to produce a new type of light, silent and aesthetical air turbine handpiece.
Dental Cavity Preparation↗
Surgical anatomy of the middle turbinate.
Clinicians have encountered many variations of the middle turbinate. Previous descriptions of the middle turbinate were only focused on its size and shape and lacked surgical implications associated with endoscopic sinus surgery. Therefore, the aim of this study was to examine the surgical anatomy of the middle turbinate in hemisected cadaveric heads. The middle turbinates from 101 hemisections of adult Korean cadaveric heads were measured using digital calipers and a protractor. The middle turbinates were then classified according to their shape. The mean distance between the anterior attachment of the middle turbinate and the anterior attachment of the superior turbinate was 18.5 mm. The posterior end of the middle turbinate extended more posteriorly than that of the inferior turbinate in 40% of the cases, while in 26.3% of the cases, the posterior end of the inferior turbinate extended more posteriorly than that of the middle turbinate. The middle turbinate was classified into three types according to the shape of its anterior border. In type 1, the anterior border of the middle turbinate ran directly posteroinferiorly from its attachment to the conchal plate, and was observed in 45.3% of the cases. In type 2, the anterior border of the middle turbinate initially coursed inferiorly from the conchal plate and then turned in a posteroinferior direction. This type was observed in 44.2% of the cases. Type 3 involved 10.5% of the cases where the anterior border bulged anteriorly before it coursed posteroinferiorly. The information provided in this report should assist surgeons when performing partial middle turbinectomies.
Adult↗
The quantitation of turbinate atrophy in pigs to measure the severity of induced atrophic rhinitis.
The two-fold purpose of this study was to establish a useful image analysis technique for quantitation of turbinate atrophy and to determine an optimum bacterial dose for inducing atrophic rhinitis (AR). Two morphometric analysis methods were compared to determine a turbinate area ratio (TAR) and a turbinate perimeter ratio (TPR); the ratios of turbinate area to total nostril area and of turbinate perimeter to total nostril perimeter, respectively. Our first image analysis method differed from Collins et al (1) in that we used direct image capture (digitalization) via a video camera and a Macintosh microcomputer, rather than photographs and a digitizer tablet. The tracing techniques were the same as those used by Collins et al. The second morphometric method was modified from the first by exclusion of dorsal turbinate when tracing the nostril area and directly tracing only the ventral turbinate to get a turbinate measurement without subtracting. Area and perimeter ratios, for both methods, were compared to conventional visual snout scores, ventral measurements, and to each other. The results of the two image analysis methods correlated well, both with each other and with the visual scores. Doses of Pasteurella multocida (Pm) at a constant level, and Bordetella bronchiseptica (Bb) at various concentrations, were administered to 36 Hampshire-Duroc F1 SPF pigs to determine the best dose and frequency for inducing AR. Although the dose selection may have been somewhat affected by the pre-existing presence of Bb, the optimal dose per naris in this study was 2 mL Bb at 10(7) cfu/mL combined with 2 mL Pm at 10(9) cfu/mL inoculum. The frequency of administration (1 x or 2 x) did not greatly affect results. Turbinate area ratio was the best tool for quantitating gross morphological turbinate changes associated with atrophic rhinitis in this study. Our simplified modification of Collins et al image analysis method (exclusion of dorsal turbinates and direct measurement of ventral turbinates) correlated well with visual scores, and, when compared to Collins et al method, required less data manipulation and labour.
Animals↗
Histopathology of the inferior turbinate with compensatory hypertrophy in patients with deviated nasal septum.
OBJECTIVE: To measure the dimensions, composition, and possible structural and/or histopathological changes of the compensatory hypertrophic inferior turbinate in patients with deviated nasal septum. STUDY DESIGN: A prospective, nonrandomized, and morphometric study. METHODS: Nineteen patients with deviated nasal septum and compensatory hypertrophy of the inferior turbinate in the contralateral nasal cavity underwent surgery for correction of nasal obstruction. Patients' specimens were compared with those of a control group consisting of 10 inferior turbinates removed at autopsy. Quantitative measurements of the inferior turbinate histological sections were carried out and included the width of the layers and morphometric calculations of the relative proportions of the soft tissue constituents. Also, qualitative study was performed to detect pathological changes. RESULTS: Of all layers, the inferior turbinate bone underwent a twofold increase in thickness and manifested the most significant expansion (P < or =.001), whereas the contribution of the mucosal layers to the inferior turbinate hypertrophy was modest. The morphometric analysis revealed a larger proportion of venous sinusoids in hypertrophic turbinates, but the difference was small and statistically insignificant. Qualitative assessment disclosed normal mucosal architecture in all inferior turbinates with compensatory hypertrophy. Eleven remained intact, while eight disclosed mild to moderate pathological changes. CONCLUSIONS: The data gathered in the present study are of importance to the decision-making process regarding turbinate surgery. The significant bone expansion and the relative minor role played by the mucosal hypertrophy would support the decision to excise the inferior turbinate bone at the time of septoplasty.
Adolescent↗
Laser treatment of hyperplastic inferior nasal turbinates: a review.
BACKGROUND AND OBJECTIVE: Since the early 80s various types of lasers have been used for the reduction of hyperplastic inferior nasal turbinates. Up to now many studies have revealed a variety of important information. To summarize these findings and to determine the value of laser treatment of hyperplastic inferior nasal turbinates, a comparative review of the literature was performed. STUDY DESIGN/MATERIALS AND METHODS: The study of the literature revealed that hyperplastic inferior turbinates of more than 2,000 patients have been treated and followed up. Treatment was performed with the CO2 (10,600 nm), diode (805/810/940 nm), Argon-ion (488/514 nm), KTP (532 nm), Nd:YAG (1,064 nm), and Ho:YAG (2,080 nm) laser in more than 20 studies so far. Generally, the authors of the trials used different laser parameters (power, energy) and application modalities (contact, non-contact, interstitial, superficial). To determine the long-term results objective (active anterior rhinomanometry, acoustic rhinometry, mucociliary function tests, allergy tests) as well as subjective parameters (questionnaire) were recorded and evaluated. In some cases morphological changes of the turbinate tissue were studied by light and scanning electron microscopy (SEM). RESULTS: Laser surgery of inferior turbinates can be performed as an outpatient procedure under local anesthesia. Due to a minimally invasive and controllable coagulation and ablation of soft tissue, almost no complications or bleedings were observed during the operation or postoperatively. Depending on the chosen parameters (power, energy) and the application modalities (contact, non-contact, superficial, interstitial) laser treatment of hyperplastic inferior nasal turbinates achieved comparable or better results than most of the conventional techniques for turbinate surgery like conchotomy, electrocautery, cryotherapy, chemical cauterization, and vidian neurectomy. More invasive (radical) operative methods, such as inferior turbinoplasty, submucous turbinectomy, lateral outfracture, partial and total turbinectomy, seemed to be more effective than laser surgery in the long-term. CONCLUSIONS: Laser treatment of hyperplastic inferior nasal turbinates can be considered as a useful, cost-effective, and time-saving procedure for the reduction of hyperplastic inferior nasal turbinates. Short operation time, good results, and minor side effects compared to other surgical methods provide an excellent clinical response of the patients.
Humans↗
Effects of middle turbinate medialization on olfaction.
OBJECTIVE/HYPOTHESIS: Turbinate medialization techniques have gained popularity in an attempt to prevent turbinate lateralization. Theoretically, adhesions between the septum and middle turbinate will prevent lateralization but may compromise airflow to the olfactory neuroepithelium and affect the sense of smell. No studies have addressed this issue. The objective of this study is to evaluate effects of middle turbinate medialization on olfaction. STUDY DESIGN: A prospective controlled study of olfaction before and after middle turbinate medialization using the University of Pennsylvania Smell Identification Test (UP-SIT) and patient questionnaires. METHODS: Fifty patients underwent endoscopic sinus surgery (ESS) with middle turbinate medialization and preservation. The caudal end of the middle turbinate and the opposing septal mucosa were abraded with a microdebrider for iatrogenic synechia formation in an attempt to avoid lateralization of the middle turbinate. Each of the patients underwent preoperative assessment with a questionnaire and UPSIT. All patients were reevaluated approximately 5 weeks after surgery by endoscopic examination, questionnaire, and the UPSIT. The preoperative and postoperative questionnaire responses were compared for subjective analysis. Objectively, the preoperative and postoperative UPSIT scores were compared using the Student t test. RESULTS: The questionnaires showed that the study population's subjective sense of smell either did not change or improved compared with the preoperative state. Objectively, there was a mean increase of UPSIT scores after surgery. This difference was not statistically significant (P = .4). CONCLUSION: Middle turbinate medialization has no detectable adverse effect on olfaction.
Adult↗
[Possibility and clinical significance of reservation middle turbinate in endoscopic sinus surgery].
OBJECTIVE: To study the possibility and significance or reservation of the middle turbinate in endoscopic sinus surgery for sinusitis and/or nasal polyps. METHODS: (1) The morphology and mucosal ultrastructure of middle turbinate were observed preoperatively and postoperatively by nasal endoscopy and scanning electron microscopy in 20 cases; (2) The proportions of the septal turbinate formation and the closure of ethmoid sinus cavity were investigated postoperatively by nasal endoscopy in 60 cases with middle turbinate reserved and 60 cases with middle turbinate resected. RESULTS: (1) The morphology and mucosal ultrastructures of reserved middle turbinate were observed to have recovered postoperatively; (2) The proportions of the septal formation and the closure of ethmoid sinus cavity in the groups with middle turbinates reserved and resected were 13.3%, 18.3% and 58.3%, 51.7%, respectively (P < 0.01). CONCLUSION: It is possible that the structure of reserved middle turbinate may return to normal and it is important to save the middle turbinates to improve clinical cure rate.
Adolescent↗
The sphenoid sinus natural ostium is consistently medial to the superior turbinate.
BACKGROUND: This study was performed to determine the location of the natural ostium of the sphenoid sinus relative to the intact superior turbinate. METHODS: Forty-seven cadaveric specimens were examined. Mucosa over the sphenoethmoidal recess, superior turbinate, and posterior ethmoid was left intact. The position of the sphenoid sinus natural ostium relative to the superior turbinate was identified. RESULTS: The sphenoid ostium was identified in all specimens. In all specimens, the sphenoid ostium was found to be medial to the intact superior turbinate, notwithstanding lateral deflection of the posterior few millimeters of the superior turbinate in some cases. CONCLUSION: The superior turbinate is an excellent landmark for the sphenoid sinus natural ostium. Previous observations of the ostium positioned lateral to the superior turbinate may have been caused by stripping of the superior turbinate mucosa before measurements were taken. In the intact specimen, the sphenoid ostium is reliably found medial to the superior turbinate.
Cadaver↗
Contamination of the turbine air chamber: a risk of cross infection.
In the present work, we evaluated (a) the influx of contaminating fluid into the air chamber when a high-speed turbine stops rotating, (b) the significance of a series of variables (type of handpiece and dental unit, shape of the bur, number of stops set on the turbine) which condition it, and (c) the time required to expel the contaminating fluid from the turbine head. Results showed that contamination takes place every time the turbine stops rotating with the bur in contact with an external fluid. The main variable affecting the influx of contaminating fluid into the air chamber of the turbine head was represented by the shape of the bur (F=54.9; p<0.01). Another significant variable was the type of handpiece and dental unit (F=7.3; p<0.01). The number of stops set on the turbine was irrelevant (F=0.03; p=n.s.). The expulsion of the contaminant from the turbine head showed 2 different exponential rates: a very rapid-elimination phase within 30 s and a slow-elimination phase between 60 and 300 s. In order to remove over 99% of the contaminant from the air chamber, a turbine had to run for more than 4-7 min depending on the type of the handpiece. In conclusion, data from the present study suggest that a significant cross-infection potential exists with high-speed handpieces whenever they are only externally scrubbed and disinfected so the internal cleaning and sterilization between patients is mandatory. The practice of flushing by running the turbines between patients should be discouraged.
Air↗
Middle turbinate stabilization technique in endoscopic sinus surgery.
BACKGROUND: Lateralization of the middle turbinate with scarring and obstruction of the middle meatus after endoscopic ethmoidectomy has accounted for a high percentage of postoperative complications. OBJECTIVE: To evaluate a suture stabilization technique of the middle turbinates in an attempt to solve this problem and preserve the middle turbinate. DESIGN: Retrospective chart review of 31 consecutive patients undergoing endoscopic sinus surgery with suture stabilization of the middle turbinate. RESULTS: With the technique of suture stabilization of the middle turbinate in 60 operated-on sides of 31 patients, 59 sides showed the middle meatus to be patent without synechia or maxillary sinus ostium obstruction postoperatively. CONCLUSION: The complication of lateralization of the middle turbinate with scarring and obstruction of the middle meatus after endoscopic ethmoidectomy can be prevented with suture stabilization of the middle turbinate, and the middle turbinate can be preserved.
Adolescent↗
Mast cell ultrastructure in the inferior turbinate and stroma of nasal polyps.
Fourteen unselected adult patients with nasal polyps had ultrastructural examination of mast cells from matching biopsies of the polyp and inferior turbinate. Between three and 10 blocks were examined for each patient in both tissues and every mast cell that had a nucleus was photographed for study. Fifty-three mast cells were found within the stroma of nasal polyps and 54 in the submucosa of the inferior turbinate biopsies. The number of granules ranged between 13 and 167 (mean 60) for polyps and 18 and 148 (mean 61) in the inferior turbinate. The mast cells appeared essentially normal in the inferior turbinate of four patients. The degree of degranulation of the mast cells was calculated as in previous studies and then averaged for both the polyp and the inferior turbinate of each patient. There was greater degranulation in the nasal polyp compared to inferior turbinate (p = 0.03). These results were compared with mast cell degranulation found in the normal nose and in the inferior turbinate of patients with perennial allergic rhinitis which we previously published. The inferior turbinates in these patients were more degranulated than the normal nose (p = 0.0001) but were similar to that found in patients with perennial allergic rhinitis. This suggested that some degree of degranulation may occur throughout the nose in two thirds of the patients with nasal polyps which supports the theory that mast cell reactions are not limited to the polyps in a proportion of patients.
Adult↗
A safe, alternative technique for inferior turbinate reduction.
OBJECTIVE: Submucous resection of the inferior turbinates is a conventional technique for reducing their size to achieve patent nasal airways in situations where an enlarged turbinate contributes to airway obstruction. Many techniques and complications have been described in the past. We describe a new inferior turbinate reduction technique performed with powered instrumentation and assess its success and complication rates. STUDY DESIGN: A prospective study of 120 consecutive patients who underwent submucous resection of the inferior turbinates with a microdebrider. METHODS: Patient questionnaires were used for subjective assessment of symptoms before and after the procedure. We graded each patient's inferior turbinates for size from I to III before and 6 weeks after surgery for objective analysis. RESULTS: The common complications of standard submucous resection of inferior turbinates include excessive resection, postoperative bleeding, and crusting. The advantage of the microdebrider technique is the precise control of the amount of tissue and location of tissue that is removed on a submucosal plane. The complications encountered with this technique are limited to postoperative bleeding that occurred in 1.6% of patients. There was no crusting or excessive removal of tissue. CONCLUSION: The results show that submucous resection of inferior turbinates with a microdebrider is a safe method of achieving turbinate size reduction with minimal morbidity.
Adult↗
Pneumatization of turbinates.
OBJECTIVES: To present unusual computed tomography (CT) findings concerning huge pneumatization of turbinates and paranasal sinuses in one patient. In current world literature the authors only found nine reports of pneumatization of inferior turbinates, which, therefore, must be considered an extremely rare anatomical finding. STUDY DESIGN: Case report and literature review. METHODS: Computed tomography findings in a 35-year-old white woman with nasal obstruction are presented; and the authors describe this additional case of pneumatization of an inferior turbinate, as well as other variants. The literature and nomenclature are reviewed. RESULTS: Besides the rare anatomical finding of a pneumatized inferior turbinate, in addition, both patient middle and superior turbinates were pneumatized bilaterally. Frontal and sphenoid sinuses were huge, with pneumatization of the crista galli and the posterior parts of the septum. The floor of the orbit presented with an orbitoethmoid (Haller) cell on one side. Thus, five of the six turbinates present were pneumatized. To the authors' knowledge, no other case of such extreme pneumatization has been published in world literature to date. CONCLUSIONS: Whereas pneumatization of the ethmoturbinals is a frequent finding on sinus computed tomography scans, pneumatization of the maxilloturbinal remains an extremely rare anatomical variant. Pneumatization of ethmoid cells and secondary sinuses is considered an active achievement of nasal and sinus mucosa during fetal development and adolescence. The underlying mechanisms of this process are not yet understood. The inferior turbinate is the least likely to present with pneumatization. In clinical practice, the pneumatization status should well be studied on the scans before any sinus and turbinate surgery is undertaken.
Adult↗
Surgical anatomy of the turbinal wall of the ethmoidal labyrinth.
The upper part of the lateral nasal wall is formed by a common structure or conchal lamina that is attached all along the junction between the ethmoidal roof and the cribriform plate. From this continuous conchal lamina, the different ethmoidal turbinates take their origin. All these structures form a well defined wall that encloses the ethmoidal cells medially and that deserves the name of "turbinal wall of the ethmoidal labyrinth". The objectives of this paper were: 1) to precisely define the anatomical landmarks of the turbinal wall of the ethmoidal labyrinth, and 2) to study, from an anatomical point of view, the consequences of the surgical resection of the middle turbinate. We performed an anatomic study on 12 frozen human heads, cut in a median-sagittal plane, and then photographed with a millimetre scale in order to perform several measurements. The surface of the turbinal wall of the ethmoidal labyrinth can range from 6.1 to 11.3 cm2. The resection of the middle turbinate preserves approximately half of the turbinal wall, this being around 4.3 cm2 (range 2.6 to 6.3 cm2). The conchal lamina appears as the noble sensorial element of the turbinal wall. It can be described as a continuous bone plate, grossly rectangular in shape, measuring approximately 1 cm in height and 3.5 cm in length that forms the lateral wall of the olfactory groove. The anatomic study shows that its dimensions can vary from simple to double in different individuals. It seems to us that instead of considering the difference of height between the cribriform plate and the ethmoidal roof (Keros classification), we should consider the vertical height of the conchal lamina as a potential risk factor in ethmoidal surgery.
Adult↗
[The distribution of nerves in inferior turbinate].
OBJECTIVE: The distribution of nerve in inferior turbinate was observed to provide anatomy evidence for inferior turbinate surgery by measuring and dissecting corpses. METHOD: Inferior turbinate was dissected under the microscope in 20 heads of corpses. RESULT: (1) The posterior inferior nasal nerve marched down between the mucosa and the periosteum, and entered the inferior turbinate at the site 6 to approximately 13 mm before the end of inferior turbinate. (2) The antierethmoid nerve went to the inferior turbinate 2.0 to approximately 4.6 mm behind the beginning of the inferior turbinate. CONCLUSION: Selective cut of the nerves of the inferior turbinate under the nasal endoscope is feasible.
Adult↗
Chronic inferior turbinate enlargement and the implications for surgical intervention.
Nasal obstruction due to chronic enlargement of the inferior turbinate is a common problem for the ENT surgeon. This review will discuss the pathology of 'bilateral' and 'unilateral' turbinate enlargement associated with chronic rhinitis and nasal septal deviation, and focus on the structural changes in the turbinates. Cellular hyperplasia, tissue oedema and vascular congestion all contribute to turbinate enlargement, but there is some evidence that bony enlargement is associated with unilateral turbinate enlargement. There is no evidence for cellular hypertrophy despite the common use of the term 'turbinate hypertrophy' and this term should be replaced with the more correct term of 'turbinate enlargement'. The underlying pathology of turbinate enlargement has important implications for the surgical management of nasal obstruction.
Chronic Disease↗
[Design-dependent transmission of bacteria by internal infection of dental turbines (author's transl)].
The results of the present investigation point to an up to now little recognized possibility of bacterial transmission by dental turbines, namely, the intake of spray water by reverse suction from the turbine hand piece into the cooling water system on turning off the unit. Reverse suction is provided in most modern dental turbine units to prevent after-drip and the cooling of the pre-warmed spray. As a consequence, microorganisms of the oral flora and possibly disease-producing bacteria may be carried into the cooling water system and thus be transmitted to the next patient when using the same turbine. In carefully planned experiments employing E. coli as test organisms it could be shown both in simulated manipulation in the oral cavity as well as in in vitro experiments that transmission of bacteria is possible in up to 10 ml of spray water ejected (equivalent to 10 spray water fractions of 1 ml each). In older model turbines without spray water reverse suction, bacteria were absent after ejection of no more than 6 ml of cooling water (in fractions of 1 ml each). In order to avoid transmission of bacteria in spray water of dental turbines it appears necessary to subject the turbine hand piece or the turbine head, resp., to rigorous disinfection and to allow delivery of at least 20 ml of spray water - corresponding to about 20 second's operation - before reusing the unit.
Bacterial Infections↗