Med. J. Cairo Univ., Vol. 79, No.

1, December: 729-732, 2011

www.medicaljournalofcairouniversity.com

Microdebrider Assissted Partial Inferior Turbinectomy;

Advantages Over the Conventional Method
HATEM BADRAN, M.D.; AHMED FATHI, M.D.; MAHMOUD ATTIA, M.D. and AHMED HESHAM, M.D.
The Department of Otorhinolaryngology, Faculty of Medicine, Cairo University

Abstract

an effective treatment for chronic nasal obstruction

[1] . Many techniques of turbinate reduction have
been performed, including partial or total turbinate
resection, cauterization, cryotherapy, laser therapy,
and radiofrequency ablation [2-6] . The multiplicity
of techniques indicates the lack of consensus on
the "gold standard" for inferior turbinate reduction.

Objective: To compare the safety and efficacy of microdebrider assisted partial inferior turbinectomy with the conventitional turbinectomy in patients with inferior turbinate hypertrophy.
Design: Prospective randomized single blinded study.
Setting: Academic Medical Center.

It has been reported that submucosal turbinectomy is an excellent procedure for reducing not
only nasal congestion but also sneezing and rhinorrhea in patients with perennial allergic rhinitis
[7,8] .

Patients & Methods: Sixty patients with nasal obstruction

and bilateral hypertrophied nasal turbinates that was refractory
to medical treatment were included. History taking, clinical
assessment and preoperative CT scan of the paranasal sinuses
were done for all patients. Patients were randomly assigned
to receive microdebrider partial turbinectomy (n=30) or
conventitional surgical turbinectomy (n=30).

A microdebrider allows us to effectively remove

the bone and soft tissue because its rotation motor
can be connected to different types of dissectors
and drills. In addition, this tool enables us to obtain
excellent surgical visualization because its attached
aspirator absorbs the resected material along with
any blood, keeping the site free of debris. Furthermore, Microdebriders help to reduce adjacent tissue
damage because there are refrigerants perfused
within the protection tube [9] .

Main Outcome Measures: Operative time, blood loss,

subjective improvement of the patients symptoms and post
operative complications.
Results: The 2 groups were comparable in age and sex.
The operative time and operative blood loss was less in the
microdebrider group (p<0.001). Follow-up visit after 3 months
revealed improvement in 93.3% of the patients in the microdebrider group vs 96.7% in the surgical group. There was no
difference in the incidence of post operative complications
between the 2 groups.

The microdebrider, which has been widely used

in nasal surgery, is supposed to provide real-time
suction with the ability of precise tissue resection
[10] . Although several studies proposed the feasibility of using the microdebrider in inferior turbinate surgery, the intraoperative differences between
the use of microdebrider & the classic turbinectomy
remained unexplored. The purpose of this study
was to evaluate the differences between both techniques.

Conclusions: Partial turbinectomy with the microdebrider

is faster than surgical partial turbinectomy & with less blood
loss. We advise to use the microdebrider as routine method
for treating nasal turbinates hypertrophy.
Key Words: Endoscopic Microdebrider Turbinectomy.

Introduction
NASAL obstruction, although not life threatening,
can interfere with quality of life. Enlargement of
the inferior turbinates is a common cause of obstruction of the nasal airway. Turbinate surgery is

Patients and Methods

This prospective randomized study was conducted at the Saudi German Hospital in Jeddah;
Saudi Arabia during the period between November
2008 and June 2010. The study was approved by

Correspondence to: Dr. Hatem Badran, The Department of

Otorhinolaryngology, Faculty of Medicine, Cairo University

729

730

Microdebrider Assissted Partial Inferior Turbinectomy; Advantages Over

the local ethics committee after taking informed

consents from the patients.

were encouraged to rinse the nasal cavity several

times a day for 2 weeks.

60 patients (18-52 years) with the diagnosis of

inferior turbinate hypertrophy, all of them had
nasal obstruction not responding to medical treatment (oral antihistamines, oral decongestants and
local steroids for 1 month).

Patients came for follow-up weekly in the 1 st

month then monthly in the next 2 months, the
patients were given a questionnaire to check for
changes in nasal obstruction after 3 months (marked
improvement, mild improvement, no change or
worse) with reporting of any post operative complications.

Patients were subjected to complete workup

including a thorough history of medical therapy,
nasal endoscopy, and CT scan of the paranasal
sinuses. Patients with a history of previous turbinate
surgery, chronic sinusitis, deviated nasal septum
and nasal polyps were excluded from the study.
Thirty patients underwent microdebrider assisted partial inferior turbinectomy and the other 30
underwent surgical partial inferior turbinectomy.
The turbinectomy technique (surgical vs. the microdebrider) was randomized by the attending
surgeon based on odd number for surgical and even
number for microdebrider. All procedures were
performed by the first author, the patients were
blinded to the technique used.
Surgeries were done under general hypotensive
controlled anesthesia with the patients positioned
in the 15 head up position. Preoperative nasal
decongestion for 10 minutes was done using cottonoids soaked in 1: 10000 epinephrine. The rigid
4mm telescopes of different angles (0 and 30 )
were used in addition to the endoscopic set of
instruments.
In the microdebrider group, hypertrophied mucosa of the inferior turbinate was trimmed with
the Xomed Power System (XPS) 4mm cutting
blade at a speed of 3000rpm in oscillate mode. In
the surgical group, the turbinate was fractured
under endoscopic guidance, angled scissors was
used to resect bone and soft tissue from the posterior
aspect of the turbinate. After tissue removal via
either technique, electrocautery was used for hemostasis.
Intraoperative parameters recorded were operative time and blood loss. The time in minutes was
recorded for each patient for tissue removal, hemostasis, and total time. Precise blood loss was
calculated by recording the exact amount of irrigation used and the exact volume of blood and irrigation in the suction canister.
For hemostasis, a sponge pack (Merocel) (Urban
and Fischer Verlag, Munich, Germany) was inserted. The patients were discharged on the same day
and the packs were removed after 48 hours. Patients

Statistical method: Data was coded and entered

using the statistical package SPSS version 15. The
data was summarized using descriptive statistics:
Mean, standard deviation, minimal and maximum
values for quantitative variables and number and
percentage for qualitative values. Statistical differences between groups were tested using Chi Square
test for qualitative variables, independent sample
t-test for quantitative normally distributed variables
while Nonparametric Mann Whitney test was used
for quantitative variables which arent normally
distributed. p-values less than or equal to 0.05
were considered statistically significant.
Results
The 2 groups were comparable in age and sex.
The microdebrider group had 60% males, whereas
the surgical group had 66% males. Demographic
and operative data of the patients were shown in
Table (1).
Blood loss was statistically different between
the 2 groups, 71mL (range, 38-273mL) for the
microdebrider vs 161mL (range, 66-445mL) for
surgical; p<0.001 (Fig. 1).
After 3 months, 26 patients (86.6%) in the
microdebrider group versus 27 patients (90%) in
the surgical group reported marked improvement
of nasal obstruction, 2 patients (6.7%) in both
groups reported mild improvement, 2 patients
(6.7%) vs 1 patient (3.3%) reported no change and
no patient reported worsening of nasal obstruction,
the difference was not statistically significant ( pvalue >0.05).
No patient had any postoperative bleeding in
the microdebrider group after pack removal. Two
patients of the surgical group (6.7%) showed secondary hemorrhage 1 week after surgery which
was controlled by antibiotics and nasal packings.
We did not encounter any crusting, foul odor,
synechia or atrophic change during the next 3
months in either group. The difference was not
statistically significant (p=0.472).

Hatem Badran, et al.

731

Table (1): Demographic and operative data.

Microdebrider
group

Surgical
group

p-value

Age (years)
Gender M/F

34.62.07
60/40

34.3 1.26
66/34

>0.05
>0.05

Operative time (min)

- Removal time
- Hemostasis time
- Total Time

6.3 1.28
2.50.53
8.8 1.46

5.55 1.07
10.2 2.3
15.753.22

>0.05
<0.05
<0.05

Blood loss (ml)

200
150
100
50
0
Microdebrider
Surgical
Fig. (1): Mean amount of blood loss (ml) among both studied
groups.

Discussion
Nasal obstruction remains a significant problem
and there are many techniques to treat the condition.
However, there are no existing treatments that have
proven to be this effective during this long period
of time [11] .
In evaluating the various methods of turbinate
reduction, we must consider the function of the
turbinate. All methods should be judged by two
basic criteria: The efficacy of the technique in
alleviating breathing obstruction and the side effects
that occur in the short and long term [12] .
The use of a microdebrider for the surgical
treatment of hypertrophic turbiinates was first
reported by Davis and Nishioka [13] in 1996, since
that time, several studies were conducted to assess
its efficacy and safety, these studies were either
using microdebrider as the only modality for turbinate reduction [11,13-16] or comparing it with
other modalities e.g. submucosal resection [17,18]
or radiofrequency [19-23] .
The paucity of studies comparing the microdebriders with the conventitional surgical instruments
encourages us to conduct this study in which we
recruit 30 patients with inferior turbinate hypertrophy excluding patients with history of previous
turbinate surgery, deviated septum, chronic sinusitis
and nasal polyps, patients were randomized into

2 equal groups with blinding the patients about the

technique used.
We used the microdebrider extraturbinally like
few studies [13,16,23] , the rest of the studies used
it intraturbinally.
The operative time was significantly less in the
microdebrider group which was due to difference
in hemostasis, this is logical due to the suction/
shaving action of the microdebrider, which draws
loose tissue into the window, as opposed to the
pushing/cutting action of the surgical instruments,
which leave more damaged tissue behind, this
difference was reflected on the difference of operative blood loss.
Subjective assessment of the patients symptoms
3 months post operatively revealed significant
improvement of both groups with no difference in
between, this was similarly reported by most of
the previous studies which was based also on
objective assessment of the nasal resistance by
rhinomanometry or acoustic rhinometry.
Post operative complications was not different
between the 2 groups, only 2 cases of secondary
hemorrhage in the surgical group. We did not
encounter any crusting, foul odor, synechia or
atrophic change during the next 3 months, though
our technique is not considered as mucosal sparing
as the intraturbinal microdebrider, submucous
resection and radiofrequency.
Lack of objective assessment of nasal obstruction is considered one of the limits of our study,
but we tried to substitute it with assessment of
operative time and blood loss which was not adequately explored in the previous studies.
There are several advantages to using a Microdebrider, since the large, well-demarcated mucosa can be removed because the surgeon's vision
is not obstructed by any bleeding. There is also a
shorter operation time, a reduction in complications
and an improvement of surgical outcomes.
Conclusion:
Partial turbinectomy with the microdebrider is
faster than surgical partial turbinectomy with less
blood loss and more precise tissue removal &
mucosal preservation.
Summary:
Hypertrophy of nasal turbinates is one of the most
common causes of nasal obstruction.
Partial turbinectomy with the microdebrider allows
us to obtain excellent surgical visualization.

732

Microdebrider Assissted Partial Inferior Turbinectomy; Advantages Over

Partial turbinectomy with the microdebrider is faster

than surgical partial turbinectomy & with less blood
loss.
Surgeon satisfaction with the microdebrider was
higher than classic endoscopic surgery.
We advise to use the microdebrider as routine
method for treating nasal turbinates hypertrophy.
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