How I Do It: Inferior Turbinectomy: Modified Techniques for Submucosal Resection

Abstract

Although inferior turbinectomy with submucosal resection effectively reduces the volume of the inferior turbinate, there is room for improvement in surgical procedures. Techniques have been developed to reduce crusting and bleeding while efficiently achieving volume reduction. State-of-the-art procedures pertaining to the local injection site, incision line, exposure of the periosteum, submucosal outfracture of the turbinate bone, trimming of redundant mucosa, and incision line suturing are described. Pre and postoperative Nasal Obstruction Symptom Evaluation (NOSE) scores and postoperative inferior turbinate bleeding and crusting were evaluated. For the 18 consecutive patients analyzed, the pre and postoperative NOSE scores were 67.8 ± 14.8 and 16.1 ± 13.0, respectively (P = .0002). Postoperatively, bleeding was absent, and only minor suture thread crusting was observed in 13 patients. In conclusion, our novel technique improves the effectiveness of surgery as well as the postoperative quality of the inferior turbinate.

Keywords: endoscopy; hemorrhage; nasal obstruction; surgical procedures; turbinates.

Conflict of interest statement

Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

© The Author(s) 2021.

Figures

Figure 1.

Intraoperative recording for submucosal resection. (A) Local injection with a 23G Cathelin needle (arrow) is performed in the submucosal tissue of the inferior turbinate. The endoscope is placed below the Cathelin needle so that the needle tip reaches the posterior end of the inferior turbinate easily. (B) A mucosal incision is made at the mucocutaneous junction with a 15c scalpel blade. (C) Using the 15c scalpel blade, a submucosal space is created to enable visualization of the submucosal tissue. (D) A microdebrider is used to resect the submucosal tissue. (E) The turbinate bone is laterally displaced with an elevator inside the mucosa so that the mucosal surface is kept intact. (F) Redundant mucosa (arrow) is cut. (G) The incision is sutured with 5-0 Vicryl. (H) Postoperatively, the incision is sutured (arrows), and the submucosal tissue is not exposed.

Figure 2.

Diagram of the operative procedure. (A) A right nasal cavity is seen from the medial side. (B) A mucosal incision is made at the mucocutaneous junction with a 15c scalpel blade. (C) Using the 15c scalpel blade, a submucosal space is created to visualize the submucosal tissue. Then, a microdebrider is used to resect the submucosal tissue. (D) The submucosal tissue is resected. (E) The incision is sutured with 5-0 Vicryl.

Figure 3.

Pre and postoperative nasal obstruction symptom evaluation scores. *P = .0002.