Turbinate Reduction

What is a turbinoplasty?

The turbinates are the bony structures on either side of the nose. These turbinates are covered with soft erectile tissue called “nasal mucosa”. The turbinates warm, humidify and purify the air that we breathe. They can swell in response to allergies or sinus infections. When they get large enough to block your breathing this is called “turbinate hypertrophy“. If medication and environmental precautions do not reduce the turbinate size and allow you to breathe well through your nose, you may need a turbinoplasty. Anything that reduces the size of the turbinates to help you breathe better is termed a “turbinoplasty.”

What are the Methods of Turbinoplasty?

The following is a list of techniques used to reduce hypertrophied turbinates that range from simple crushing the bone of the turbinate laterally, to completely remove the turbinate.

1. Turbinate outfracture: The turbinate is crushed laterally away from the nasal septum from the area near the nostril to further back in the nose. This is done with a round metal instrument (Goldman bar) and compresses the bone while doing little to the soft tissue.
2. Coblation turbinate reduction: The soft tissue of the turbinate is “cooked” at low temperatures to shrink the turbinate size. As the turbinate heals the scarring will contract the outer layer of the turbinate and help open the airway. Coblation is a contraction for “controlled ablation.”
3. Laser turbinoplasty: In this method, an optical fiber is used to deliver high-temperature light to the surface of the turbinate. Grooves are cut into the turbinate surface which shrinks the soft tissue of the turbinate. Over time the surface scars and shrinks further before the normal soft tissue mucosa regrows over the turbinate in a few weeks.
4. Cautery turbinate reduction: An electrical current is run through the turbinate with the patient grounded to a grounding pad. The high heat produced will “cook” the soft tissue and shrink it. This can be used in any form of turbinate reduction to control bleeding.
5. Submucosal turbinate reduction: Possible the most effective technique for large turbinates. In this technique, a cut is made in the front of the turbinate and the anterior turbinate bone dissected out and removed. The mucosa is then draped over the area where the bone was removed decreasing the bulk of the turbinate. Often times the excess soft tissue is also removed anteriorly and inferiorly and the remaining soft tissue wrapped around the area of reduction.
6. Partial turbinoplasty: This is only rarely used by surgeons training today. In this technique, the entire front of the inferior turbinate is cut off with scissors. Bleeding can be profuse and is controlled with cautery as described above. This has a much higher risk of “empty nose syndrome” which is when the inside of the nose is “too open” but paradoxically you feel like you can’t breathe through your nose.
7. Total turbinoplasty: The scissors are used to completely remove the entire turbinate. This technique is virtually guaranteed to cause “empty nose syndrome” and should not be used for the improvement of breathing.

Can you pair a septoplasty with a turbinoplasty?

Septoplasty is straightening of the deviated nasal septum, the wall that divides the left and right sides of the nose. Making the nasal septum less deviated may bring the septum closer to one or both of the turbinates. If you have a deviated septum and turbinate hypertrophy you would want both of these procedures performed at the same time whenever possible.

How is the recovery for a turbinoplasty?

You can expect a week or so of congestion after turbinoplasty. Breathing should improve over the next few months. We bring you into the office for evaluation at one week after surgery and then as needed. Please feel free to call our office if you have nasal obstruction.