**Conflict of interest**

*Rhinosinusitis*

[6, 76, 77].

**3. Conclusions**

basis of symptoms [79].

**Acknowledgements**

a headpiece, activated by a QMR machine, so-called Quantum (Telea, Sandrigo-Vicenza, Italy), for a total of 20–30 s, at an intensity force of 3.5, with immediate causes a shrinkage of the mucosa. Since this is a substantially new technique, even if a special dedicated bipolar electrode exists and it is already operating regularly,

The injection of a "long acting" steroid solution is a minimally invasive method, which still guarantees a rather limited benefit over time (it is maximum after 1 week and generally lasts for no longer than a month). It is performed by a slow submucosal injection of triamcinolone acetonide at the level of the turbinate head. A possible complication, even if extremely rare, consists of a transient or permanent loss of sight, which is thought to derive from a retinal vasospasm or a retrograde embolization affecting the retinal circulation (devastating retinal thromboses can also occur)

The great interest in turbinate surgery is documented by the large number of surgical techniques proposed over the years and by the production of specific surgical devices by the healthcare industry. However, this diversity of opinions and the quantity of proposed techniques, all valid and scientifically documented, underlines the continuous research to balance the need to solve the obstruction and to maintain the function of the nasal mucosa that unfortunately, in chronic pathologies, like vasomotor rhinitis, is still severely damaged. In literature, in fact, a reduction in epithelial thickness and disappearance of ciliated and goblet cells, the absence of tight junctions, nasal mucus overproduction, inflammatory infiltration in lamina propria [73], marked disruption of the intercellular spaces, and frequent basement membrane interruption [78] can be observed. The lack of mucociliary clearance, absence of tight junctions, widening of intercellular spaces, and discontinuity of the basement membrane induce a reduction in epithelial defense functions, so that environmental factors may directly act on subepithelial structures. As a result, in the nasal respiratory mucosa, an increased responsiveness of trigeminal afferent fibers and secretory and vascular reflexes might occur representing the

The presence of these profound alterations makes us understand that a preservation of histologically altered mucosa translates inevitably into maintaining an impaired nasal function. On the other hand, it was to demonstrate [2] that the total removal of the nasal mucosa with "cold technique," without high temperatures, that burned and damaged the edges of the removed mucosa, results in a subsequent

For this reason, any technique, among those described, the surgeon want to adopt, in any case will have to follow any simple rules: do not use high temperatures, do not remove bone tissue and remove all the hypertrophic and damaged mucosa.

I have to thank Dr. Fiorella Cazzato who, with skill and ability, illustrated the present work by enriching it with the original explanatory drawings of various

complete ultrastructural restoration of the healthy tissue.

there are only a few references in the current literature [6, 75].

*2.4.3.7 Submucosal corticosteroids injection*

**146**

techniques.

The authors declare that there is no conflict of interest regarding the publication of this article. All authors have seen and approved the manuscript being submitted. We warrant that this chapter is the authors' original work. We warrant that the chapter has not received prior publication and is not under consideration for publication elsewhere. This research has not been submitted for publication nor has it been published in whole or in part elsewhere. We attest to the fact that all authors listed on the title page have contributed significantly to the work, have read the manuscript, attested to the validity and legitimacy of the data and its interpretation, and agreed to its submission.
