**Abstract**

Chronic nasal obstruction due to hypertrophic rhinitis is commonly associated with perennial allergic and nonallergic rhinitis. It is not a simple enlargement of mucosal and submucosal tissues, but it is characterized by deep histological modifications. This pathology, a very frequent condition encountered in rhinological practice, has a significant impact on quality of life. Patients usually complain about sneezing, rhinorrhea, frontal headache, postnasal drip, snoring, blocked nasal ducts, and sleep disorders. When medical therapy fails, surgical reduction of inferior turbinates is mandatory. A large variety of surgical techniques in literature exist, but there is a lack of consensus about which is the proper technique to perform. In this chapter, we describe the most important techniques of inferior turbinate reduction with advantages and disadvantages of each one.

**Keywords:** turbinate hypertrophy, nasal obstruction, nasal surgery, techniques, turbinoplasty

## **1. Introduction**

Chronic nasal obstruction is a very frequent condition in rhinological practice that severely interferes with the quality of life [1]. The most common cause of this complaint is chronic hypertrophic rhinitis. It consists of a chronical swelling of the inferior turbinate [2].

Turbinate hypertrophy, commonly associated with perennial allergic and nonallergic rhinitis [1], is not a simple enlargement of mucosal and submucosal tissues, but it is characterized by deep histological modifications such as severe damage of the epithelial barrier, disappearance of ciliated and goblet cells, inflammatory infiltration of the lamina propria, fibrosis, prominent venous congestion, and basement membrane interruption [2].

Patients generally complain about sneezing, rhinorrhea, postnasal drip, frontal headache, blocked nasal passages, sleep disturbance, and snoring [3].

When medical treatment with topical corticosteroids, antihistamines, and decongestants fails, surgical reduction of inferior turbinates could be attempted.

#### **Figure 1.**

*The radiologic study with head-CT shows a normal anatomy of the turbinates and the nasosinusal system.*

**Figure 2.** *Rhinomanometric evaluation before (A) and after (B) application of nasal topical decongestant shows the improvement of respiratory nasal flux.*

The goal of turbinate surgery is to improve nasal patency by minimizing complications such us postoperative hemorrhage, crusting, foul odor, and the "empty nose syndrome" [4].

There is a variety of turbinate procedures, but there is a lack of consensus about which technique is the best [5].

Turbinate hypertrophy can be divided into primary and secondary. The primary hypertrophy is related to the submucosal component, while the secondary hypertrophy is due to contralateral septal deviation and is related to the bony component of the turbinate. It is important to distinguish these two types of hypertrophy in order to decide the proper procedure to perform. The anatomic radiologic study (**Figure 1**) and the rhinomanometric evaluation (**Figure 2**) are mandatory for surgical indication [6].

## **2. Surgical techniques**

Turbinate reduction techniques can be divided into four categories [7]:

**135**

**Figure 3.** *Total turbinectomy.*

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

3.Microdebrider-assisted turbinoplasty (extramucosal technique)

It is a technique that was described for the first time in the last 10 years of the nineteenth century. Jones in 1895 and Holmes in 1900 introduced the concept of

This technique is considered the most radical surgical technique on the inferior turbinate. After having fractured, the bone plate of the inferior turbinate (**Figure 3**), levering from the inferior meatus, with an angled scissors, the inferior turbinate is dissected for its entire length remaining adherent to the lateral wall of the nasal cavity. For the immediate benefit that the patient obtains, it is often considered as safe and effective though its major complication is the possible bleeding, avoidable, however, both using adequate nasal swabs and avoiding to treat patients who take

Unfortunately, this type of surgery, extremely aggressive, can later lead to dry nose syndrome or even the syndrome of the empty nose with a paradoxical obstruction. The obstructive event is due to the loss of normal nasal resistance and the formation of a laminar air column. This situation causes a poor contact between the air and the nasal walls, the mucosa, due to the absence of the sensory fibers of the

The altered aerodynamics pattern, due to total turbinectomy, generates many complications such as copious postoperative bleeding, quantitative reduction of the ciliary movement, mucosal dryness, and deficit of mucus clearance. All this

inferior turbinate, shows a reduction or even a loss of the respiratory flow [6].

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

**2.1 Extramucosal debulking procedures**

These procedures include:

1.Total turbinectomy

2.Partial turbinectomy

*2.1.1 Total turbinectomy*

total turbinectomy [8].

anticoagulants [9].


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