Turbinate hypertrophy

Turbinate hypertrophy

The turbinates are structures that are found within each of the nasal cavities which are bony structures covered with hypervascular mucosa.

Their function within the normal nasal physiology consists in conditioning (humidification, purification and heating) of the air we breathe in order to improve gaseous exchange.
Typically, you have 3 turbinates: lower, middle and upper; some people there is a fourth swirled, one called supreme turbinate.

Turbinate hypertrophy

The turbinates that mostly affect the flow of air are the lower and the middle. Some individuals have an increase in their volume (turbinate hypertrophy) Fig. 2

turbinate hypertrophy

Turbinate hypertrophy prevents normal nasal breathing; the patient, in this case presents with unilateral or bilateral nasal obstruction with mouth breathing, resulting in dry mouth, runny nose and can have snoring at night (Snoring could be due to several other causes).
Among the major causes of turbinate hypertrophy, allergic rhinitis and non-specific nasal hyperactivity are the common ones.
Firstly, Allergic rhinitis may be seasonal or perennial, and the patient presents with respiratory obstruction, sneezing, running nose, itching and burning sensation ; the latter, those from non-specific nasal hyperactivity, are linked to an allergic-like reaction with a symptoms not very different from that of allergic rhinitis characterized mostly by rhinorrhea and nasal obstruction. In this case the patient may present with variations in symptoms related to hot or cold climate, variation in position or moisture, emotional state or even to cigarette smoking.

 

Treatment

After careful clinical evaluation of the patient and having ascertained the causes of the reported disturbance it can be treated with inferior turbinate reduction surgically addressing its size. Several surgical techniques have been used for the reduction of the inferior turbinate; they range from the traditional treatments in general anesthesia like partial turbinectomy or submucosal reduction in size. In recent years, new less invasive techniques like laser or radio frequencies have been employed as well.
At our centre, for some years, we use the Vesalius Quantum (Quantum molecular resonance cautery), Fig. 3 which aims to create a decongested submucosa through the tunnels drilled inside the turbinate, creating shrinkage of the mucosa itself with the objective of increasing the breathing space. The operation is performed in an outpatient setting under local anesthesia (Anesthetic agent instilled into the nasal cavity) in the operating room to monitor the vital signs of the patient with the assistance of an anesthetist. It is absolutely not necessary to make any nasal packing in the postoperative period and the duration of treatment is few minutes only. The patient can return soon to their occupations and it is necessary for some post-operative follow ups. The results are excellent and will be around 80%. It is, however, possible to repeat the treatment after a certain period if the results obtained are not satisfactory.

turbinate hypertrophy fig3