Dr. Supreet Singh Nayyar, AFMC 2012

www.nayyarENT.com

1

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

Wegener’s 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 (wegener’s, 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

Dr. Supreet Singh Nayyar, AFMC 2012

www.nayyarENT.com

2

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

Dr. Supreet Singh Nayyar, AFMC 2012

www.nayyarENT.com

3

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

. Partial turbinectomy Inferior turbinoplasty.

Complications

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