Dr.

Supreet Singh Nayyar, AFMC

2012

Inferior Turbinate Hypertrophy

Pathophysiology
Inferior turbinate hypertrophy can result from o Mucosal hypertrophy o Bony hypertrophy o Both Bony hypertrophy causes a fixed structural obstruction and is best treated with surgery More commonly, the problem is mucosal hypertrophy causing impingement on the nasal valve, increased nasal resistance, and nasal obstruction This can be managed medically or surgically depending on the degree of hypertrophy and responsiveness to medical management

Aetiology
Post rhinoplasty Allergic rhinitis Vasomotor rhinitis Chronic rhinosinusitis DNS to opposite Congenital Rhinitis medicamentosa Pregnancy OCPs Hypothyroidism Wegeners granulomatosis Sarcoidosis

History
Nasal obstruction Alteration or unilaterality may indicate a dynamic versus structural problem Features of allergic rhinitis vasomotor rhinitis Nasal decongestant usage H/o nasal surgery

Examination
Patency of the nasal valve cottle Anterior rhinoscopy o Septal deformities o Inferior turbinate hypertrophy o Apply topical decongestant to evaluate the response of the turbinate mucosa assist in delineating mucosal versus bony hypertrophy Rigid or flexible nasal endoscopy Purulent drainage may indicate sinusitis Signs of other systemic disorders (wegeners, hypothyroidism)

Investigations
Xray PNS CT is not indicated in the workup of inferior turbinate hypertrophy alone. However, if a CT scan of the head, facial bones, or sinuses has been obtained for other reasons, it may provide useful information bony versus mucosal hypertrophy

Rhinomanometry / acoustic rhinometry Allergy testing

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Dr. Supreet Singh Nayyar, AFMC

2012

Medical Therapy
Therapy for allergic and vasomotor rhinitis Submucosal injection of corticosteroids has been tried results are rapid but temporary relief incidence of permamnent blindness noticed therefore now abandoned

Surgical Therapy
Surgical therapies o Reposition the turbinate o Address mucosal hypertrophy o Address bony hypertrophy o Address both mucosal and bony hypertrophy Repositioning the turbinate o Laterally within the nasal valve area is accomplished by lateral out-fracture o This technique does not address either mucosal or bony hypertrophy but rather the spatial relation of the inferior turbinate within the nasal valve Mucosal hypertrophy o Submucosal techniques Designed to produce submucosal tissue injury while preserving overlying mucosa Resultant tissue loss and subsequent scarring lead to a reduction in bulk of the inferior turbinate mucosa and submucosa Techniques Submucosal diathermy Microdebridder Cryotherapy Coblation Radiofrequency Ultrasonic aspirator

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Dr. Supreet Singh Nayyar, AFMC o Surface electrocautery o Laser vaporization Bony hypertrophy o Submucous resection Periosteal flap is developed Underlying bone removed Flap is replaced Mucosal and bony hypertrophies o Best dealt with via a partial inferior turbinectomy or inferior turbinoplasty

2012

Partial turbinectomy

Inferior turbinoplasty.

Complications
Epstaxis Synaechiae Dryness and crusting / atrophic rhinitis Turbinate bone necrosis and sequestrum requires removal of sequestrum

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