*2.2.6 Infrared coagulation*

Infrared coagulation (IC) has been performed for the first time in 1975 by Nath and Kiefhaber [45]. The light reflects from a 15-V tungsten-halogen lamp from a gold surface. The reflected light has been a spectral maximum in the infrared range: 10,000 A. The tip causes a thermal necrosis on the tissue at 100°C without surface adhesion or carbonization [46]. IC of inferior turbinate seems to be easy to use and safe. It has low cost and patient acceptance. These features make it an attractive alternative to other methods currently used for turbinate reduction [46]. However, the efficacy of this method is especially on the head of inferior turbinate, because the tip is bulky and has an angle of 30° with their column and is hard to perform on the posterior portion of the turbinate [46].

**141**

*Turbinate Surgery in Chronic Rhinosinusitis: Techniques and Ultrastructural Outcomes*

The inferior turbinate lateralization is a routinely performed procedure. It is a simple technique introduced by Killian in 1904 in order to avoid turbinectomy complications [34, 47]. It is usually performed by using a Goldman or a Freer elevator or a long nosed nasal speculum. The procedure usually begins with an infracture of the inferior turbinate bone (the inferior aspect of the turbinate is pulled medially). An external force is then applied to the turbinate leading to a bone fracture and a dislocation of the turbinate to the lateral nasal wall (**Figure 5**) [48]. This procedure does not modify the anatomy of the surrounding structures, dislocate the uncinate process [49], and close the Hassner valve; hence, there is no blockage of lacrimal duct. However, the outfracture provides only a temporary improvement of nasal respiration, because the dislocated turbinate often resumes its original position [50]. Generally, this procedure is associated with septoplasty or rhinoplasty. It is also associated with other turbinate reduction techniques because it does not treat the hypertrophy of the turbinate. It is particularly indicated in cases of bony hypertrophy. In order to perform this procedure, it is necessary that the inferior meatus is

In 1990, O'Flynn et al. invented the "multiple submucosal outfracture" (**Figure 6**) in order to improve the efficacy of the outfracture procedure: a little incision is practiced at the cephalic portion of the turbinate near the turbinate bone; the mucosa and the submucosa are elevated with a periosteal elevator and the turbinal bone is fractured into six to eight portions and the bony fragments are dislocated laterally [52].

It was described for the first time by Fateen in 1967. It consisted in a dislocation of the inferior turbinate into the maxillary sinus after antrostomy or demolition of part of the lateral nasal wall [53]. Although the efficacy of this technique had no

*DOI: http://dx.doi.org/10.5772/intechopen.84506*

sufficiently large to contain the dislocated turbinate [51].

*2.3.2 Conchopexy or concho-antropexy*

success, it is now considered obsolete.

Submucosal procedures include:

2.Cold technique turbinoplasty

ii.With electronic tools

3.Thermal turbinoplasty

ii.Laser surgery

i.Diatermocoagulation

iii.Radiofrequency (RFAIT)

iv.Radiofrequency coblation technique (RFCT)

i.With manual instrumentation

1.Submucous resection (or turbinectomy)

**2.4 Submucosal procedures**

*2.3.1 Inferior turbinate lateralization*

## **2.3 Turbinate dislocation techniques**

Turbinate dislocation techniques include:


*Turbinate Surgery in Chronic Rhinosinusitis: Techniques and Ultrastructural Outcomes DOI: http://dx.doi.org/10.5772/intechopen.84506*

#### *2.3.1 Inferior turbinate lateralization*

*Rhinosinusitis*

allergic rhinitis [38].

*2.2.4 Cryoturbinectomy*

*2.2.5 Argon plasma coagulation*

as into nasal region [45].

*2.2.6 Infrared coagulation*

on the posterior portion of the turbinate [46].

Turbinate dislocation techniques include:

1.Inferior turbinate lateralization (or outfracture)

**2.3 Turbinate dislocation techniques**

consists in protein degeneration [37]. This action on turbinate mucosa is aggressive and damages the mucociliary function. We can study the mucociliary function with the "saccharine time" (ST) [36]: when a saccharine granule is adhered to the nasal mucosa it is dissolved within 1 min, the molecules are then transported to the nasopharynx where the patient recognizes the sweet taste, if the ST is short there is an efficient mucociliary function. In 2008, many authors showed that the "saccharine time" (ST) has been reduced in the early and late period after the TCA application. TCA treatment can induce inhibition of Th2 cell infiltration, a condition typical of

This method is characterized by an application on the surface of inferior turbinate of nitrous oxide for a period of 90–120 s at the −40/−80°C. The cryotherapy causes the formation intracellular of ice crystals and the demolition of cell membrane [39]. A recent paper suggests that regeneration of healthy ciliated nasal epithelium is a constant feature without evidence of scarring [40]. The efficacy on vasomotor rhinitis has been showed [39], but is not sustainable overtime [41].

Argon plasma coagulation (APC) originally has been used on gastrointestinal lesions under endoscopy then it has been introduced into otolaryngological field [42]. In this method, the current flow is conducted through ionized argon gas (socalled plasma)[43]. The equipment consists of a deliverer of argon gas connected to a high-frequency current generator; the argon, ionized by the monopolar current, covers the surface of the area to be coagulated, without touching it, with a penetration inside the tissue of not more than 2–3 mm [44]. The short tissue vaporization, the rapid application, and the very short propagation of postcoagulation smoke bring further advantages in the performance of small operations in restricted areas

Infrared coagulation (IC) has been performed for the first time in 1975 by Nath and Kiefhaber [45]. The light reflects from a 15-V tungsten-halogen lamp from a gold surface. The reflected light has been a spectral maximum in the infrared range: 10,000 A. The tip causes a thermal necrosis on the tissue at 100°C without surface adhesion or carbonization [46]. IC of inferior turbinate seems to be easy to use and safe. It has low cost and patient acceptance. These features make it an attractive alternative to other methods currently used for turbinate reduction [46]. However, the efficacy of this method is especially on the head of inferior turbinate, because the tip is bulky and has an angle of 30° with their column and is hard to perform

**140**

2.Conchopexy

The inferior turbinate lateralization is a routinely performed procedure. It is a simple technique introduced by Killian in 1904 in order to avoid turbinectomy complications [34, 47]. It is usually performed by using a Goldman or a Freer elevator or a long nosed nasal speculum. The procedure usually begins with an infracture of the inferior turbinate bone (the inferior aspect of the turbinate is pulled medially). An external force is then applied to the turbinate leading to a bone fracture and a dislocation of the turbinate to the lateral nasal wall (**Figure 5**) [48]. This procedure does not modify the anatomy of the surrounding structures, dislocate the uncinate process [49], and close the Hassner valve; hence, there is no blockage of lacrimal duct.

However, the outfracture provides only a temporary improvement of nasal respiration, because the dislocated turbinate often resumes its original position [50]. Generally, this procedure is associated with septoplasty or rhinoplasty. It is also associated with other turbinate reduction techniques because it does not treat the hypertrophy of the turbinate. It is particularly indicated in cases of bony hypertrophy. In order to perform this procedure, it is necessary that the inferior meatus is sufficiently large to contain the dislocated turbinate [51].

In 1990, O'Flynn et al. invented the "multiple submucosal outfracture" (**Figure 6**) in order to improve the efficacy of the outfracture procedure: a little incision is practiced at the cephalic portion of the turbinate near the turbinate bone; the mucosa and the submucosa are elevated with a periosteal elevator and the turbinal bone is fractured into six to eight portions and the bony fragments are dislocated laterally [52].

#### *2.3.2 Conchopexy or concho-antropexy*

It was described for the first time by Fateen in 1967. It consisted in a dislocation of the inferior turbinate into the maxillary sinus after antrostomy or demolition of part of the lateral nasal wall [53]. Although the efficacy of this technique had no success, it is now considered obsolete.

#### **2.4 Submucosal procedures**

Submucosal procedures include:

	- i.With manual instrumentation
	- ii.With electronic tools
	- i.Diatermocoagulation
	- ii.Laser surgery
	- iii.Radiofrequency (RFAIT)
	- iv.Radiofrequency coblation technique (RFCT)
