Powered submucous resection of the inferior turbinate

Amaç: Bu çalışmada, alt konka hipertrofisinde endoskop ile güçlendirilmiş görüş altında submüköz rezeksiyon deneyimlerimizin sunulması ve tedavinin morfolojik ve fonksiyonel sonuçlarınının vurgulanması amaçlandı. Hastalar ve Yöntemler: Alt konka hipertrofili 64 hastaya iki yıllık bir süre içersinde mikrodebrider ile bilateral turbinoplasti uygulandı. Bütün hastalara dekonjesyon öncesi ve sonrası, ayrıca ameliyat öncesi ve sonrası nazal endoskopi, Cottle testi, görsel analog skala (VAS) değerlendirmesi ve nazal pasajın akustik rinometri ve rinomanometri ile objektif değerlendirmesi yapıldı. Hastalar ameliyat sonrası bir yıl takip edildi. Bulgular: Görsel analog skala değerlendirmesine göre nazal solumada belirgin düzelme görüldü (2.12 puan artış, %60). Toplam en küçük krosseksiyonel alanda 0.42 cm2 (%36) ve toplam nazal hacimde 3.82 cm3 artış görüldü (%32). Toplam nazal direnç 0.34 Pa/cm3/dk azaldı (%47). Nazal solumanın bütün fonksiyonel postoperatif verileri dekonjestansız halde iken toplandı. Sonuç: Mikroderbiderle güçlendirilmiş submüköz tubinoplasti, mukozanın korunarak mukoza altı ve kemiğin hassas rezeksiyonunu sağlar. Bu teknik, alt konkaların fonksiyonunu koruyarak optimal hacim küçültülmesine olanak tanıması nedeniyle tercih edilir.
Anahtar Kelimeler:

Turbinatlar, Hipertrofi, Burun kavitesi

Güçlendirilmiş submüköz inferior konka rezeksiyonu

Objectives: The objectivesof the present our experience with endoscopic powered modification of the submucous resection in inferior turbinate hypertrophy and to underline the morphological and functional results of the treatment. Patients and Methods: Sixty-five patients with inferior turbinate hypertrophy were treated by bilateral turbinoplasty with microdebriders for a period of 2 years. All patients underwent nasal endoscopy, Cottle's test, visual analogue (VAS) scale assessment and objective functional evaluation of nasal patency by acoustic rhinometry and rhinomanometry before and after decongestion before the operation. The patients were followed up to 1 year postoperatively. Results: VAS showed marked improvement in nasal breathing – increased by 2.12 points (60%). Total Minimal Crossectional Area (TMCA) –increased by 0.42 cm2 (36%) and the Total Nasal Volume (TNV) increased by 3.82 cm3 (32%). The Total Nasal Resistance (TNR) – decreased by 0.34 Pa/cm3/sec (47%). All postoperative data for the functional assessment of the nasal breathing were collected without decongestion. Conclusion: Powered submucous turbinoplasty with microdebriders allows precisely controlled resection of submucosa and bone with mucosal preservation, making this technique, the method of choice enabling optimal volume reduction with preservation of function of the inferior turbinate.

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1) Hol MK, Huizing EH. Treatment of inferior turbinate pathology: a review and critical evaluation of the different techniques. Rhinology 2000;38:157-66.

2) Setcliff R, Parsons D. The Hummer: new instrumentation for functional endoscopic sinus surgery. Am J Rhinol 1994;8:275-7.

3) Benchev R, Boyadzhiev G. Our experience in the surgical treatment of nasal polyposis with microdebriders. Otorhinolaryngology 2004;1;38-41.

4) Benchev R. Submucosal inferior turbinoplasty with microdebriders. Otorhinolaryngology 2005;2:40-1.

5) Mabry RL. “How I do it” plastic surgery. Practical suggestions on facial plastic surgery. Inferior turbinoplasty. Laryngoscope 1982;92:459-61.

6) Mabry RL. Surgery of the inferior turbinates: how much and when? Otolaryngol Head Neck Surg 1984; 92:571-6.

7) Grymer LF, Illum P, Hilberg O. Septoplasty and compensatory inferior turbinate hypertrophy: a randomized study evaluated by acoustic rhinometry. J Laryngol Otol 1993;107:413-7.

8) Passali D, Lauriello M, Anselmi M, Bellussi L. Treatment of hypertrophy of the inferior turbinate: long-term results in 382 patients randomly assigned to therapy. Ann Otol Rhinol Laryngol 1999;108:569-75.

9) Passali D, Mezzedimi C, Passali GC, Nuti D, Bellussi L. The role of rhinomanometry, acoustic rhinometry, and mucociliary transport time in the assessment of nasal patency. Ear Nose Throat J 2000;79:397-400.

10)Passali D, Passali FM, Damiani V, Passali GC, Bellussi L. Treatment of inferior turbinate hypertrophy: a randomized clinical trial. Ann Otol Rhinol Laryngol 2003;112:683-8.

11)Davis WE, Nishioka GJ. Endoscopic partial inferior turbinectomy using a power microcutting instrument. Ear Nose Throat J 1996;75:49-50.

12)Van delden MR, Cook PR, Davis WE. Endoscopic partial inferior turbinoplasty. Otolaryngol Head Neck Surg 1999;121:406-9.

13)Friedman M, Tanyeri H, Lim J, Landsberg R, Caldarelli D. A safe, alternative technique for inferior turbinate reduction. Laryngoscope 1999;109:1834-7.

14)Lee CF, Chen TA. Power microdebrider-assisted modification of endoscopic inferior turbinoplasty: a preliminary report. Chang Gung Med J 2004;27:359-65.

15)Berger G, Hammel I, Berger R, Avraham S, Ophir D. Histopathology of the inferior turbinate with compensatory hypertrophy in patients with deviated nasal septum. Laryngoscope 2000;110:2100-5.

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