INTRODUCTION
One of the most frequently occurred human health problems is nasal obstruction caused mainly by inferior turbinate hypertrophy (ITH), resulting in an anatomical malfunctioning bodily compartment.1
It has been confirmed that the anterior end of the inferior nasal turbinate is the specific location in which high rates of nasal resistance cases are clinically presented. The ITH can be initiated as a result of different nasal health issues such as infectious rhinitis, allergies, eosinophilic syndrome, medications, vasomotor malfunction, and iatrogenic rhinopathy. The ITH can be mucosal or bony, which allows for better decisions by the surgeon to use surgical interventions for the cases that show no response to medical measures.2 There are several surgical procedures that can be employed to improve the ITH. Even though there are several surgical techniques, the interventional procedure chosen should be successful in providing long-term ITH size reduction accompanied by existence of a properly working turbinate that shows little or no complications.3
Turbinoplasty or submucosal resection was suggested to provide promising evidence of an ideal ITH size reduction technique, especially after introducing microdebrider as a beneficial tool in nasal surgeries, allowing for comfortable and trustful performing of ITH size reduction with the employment of the powered system.4–6
For the better understanding of the advantages and disadvantages of the powered endoscopic turbinoplasty (PET), this surgical interventional study was focused on comparing the final outcomes of partial inferior turbinectomy (PIT) and PET using the rate of occurrence of postoperative complications, such as bleeding, crustation, and atrophic rhinitis, as an evaluating system for the success of these methods.
MATERIALS AND METHODS
Subjects
The international and national ethical principles were carefully followed. Fifty patients who suffered from nasal obstruction were randomly divided into two groups: PIT group, with 25 patients, of which 15 (52%) were males and 10 (48%) were females, at an average age of 27.40 ± 7.7 years, and PET group, with 25 patients, out of which 14 (48%) were males and 11 (62%) were females, at an average age of 26.68 ± 6.82 years as shown in Figure 1.
FIGURE 1. Male-to-female ratio in powered endoscopic turbinoplasty.
Techniques
The techniques were performed under general anesthesia.
Partial inferior turbinectomy
The PIT technique was ensured by initiating inferior turbinate lateralization using freer elevator, followed by hypertrophied tissue (mucosa, submucosa, and bony structures) removal with the use of a turbinectomy scissor and a head light (conventional instruments).
Powered endoscopic turbinoplasty
Using a zero-angled endoscope, the PET was performed to dissect the soft tissues of the inferior turbinate at its vertical portion using a microdebrider with an oscillate-mode-based straight blade. A major amount of the soft tissues plus the turbinate bone were then removed using the forward-mode-directed microdebrider taking extra precautions to preserve the medial part of the soft tissues of bony lamella. Any remaining bony fragments were removed using a malleable probe and a pediatric backbiter. Later, lateral mucosa and bone were dissected.
Postoperative examination for the presence of complications
The criterion followed for deciding the successfulness of each surgical method was the rate of occurrence of postoperative complications such as bleeding, crustation, and atrophic rhinitis. The cases were endoscopically examined for the presence of nasal blood clots or bleeding, crust-like structures, and atrophic rhinitis. The time points for such examinations were Week No.1, Week No. 4, and Week No. 12 after the surgical interventions.
Statistical analysis
GraghPad Prism v7.00 was used to process the data using Student’s t-test. The data are presented as mean ± SE unless it is mentioned. The rejection of the null hypothesis was decided if P was less than 0.05.
RESULTS
The PET group showed significantly lower incidence of bleeding (P < 0.0001) (Figure 3) and crustation (Figure 4) than those from the PIT group; however, no significant differences (P > 0.05) were observed between PIT and PET in the occurrence of atrophic rhinitis (data not shown).
FIGURE 2. Male-to-female ratio in partial inferior turbinectomy.
FIGURE 3. The occurrence of postoperative bleeding in partial inferior turbinectomy or powered endoscopic turbinoplasty. Significant differences are shown (P < 0.0001).
FIGURE 4. The occurrence of postoperative crustation in partial inferior turbinectomy or powered endoscopic turbinoplasty. Significant differences are shown (P < 0.0001).
DISCUSSION
This research provides information about the successfulness of both surgical strategies, PIT and PET, in removing the turbinate hypertrophied structures blocking the nasal passage; however, PET has more advantages over PIT.
In the case of the blood clots or presence of bleeding, PET showed the lowest rates when compared to the high results from PIT. The procedure by PET provides an excellent surgical intervention with less traumatized tissues, leading to less postoperative presence of blood clots in the nasal airways. Interestingly, the postoperative crust formation was lesser in the PET than that after performing the PIT technique. The presence of crustation can be due to excessive damages applied directly on the mucosa by PIT; however, the soft tissue medial was kept intact when using the PET technique. The PET, according to this, ensures a proper working mucociliary clearance system. On the other hand, PIT causes major damages to the mucociliary epithelium, leading to the presence of postoperative blood clots and crusts. Moreover, the PET ensures careful and complete removal of all bony fragments with proper positioning of mucosal flap, which enhances better healing with less or no blood clots or crust formation.7,8
It has been reported that ITH can be treated with several methods; however, all of those techniques (such as cryosurgery, surface electrocautery, and total turbinectomy) cause direct tissue damage leading to the development of malfunctioned turbinate.9 Though some techniques provide submucosal tissue reduction with the use of some agents such as injection of steroids, however, the action of this preservation can be maintained only for a short period of time.10
The PET technique is the most reliable method that can enhance ITH reduction with minimal occurrence of postoperative complications such as bleeding and crustation. On the other hand, the rigid endoscope-based turbinoplasty is highly preferred in the ITH reduction techniques.11–15
CONCLUSION
PET shows promisingly less postoperative complications than PIT.