Turbinate Reduction Techniques in Rhinoplasty

The Problem

Nasal airway obstruction due to inferior turbinate hypertrophy.

The Background

When planning a facial cosmetic procedure such as a rhinoplasty, the ideal result should meet the aesthetic goals of both patient and physician without sacrificing function. This is especially important when considering the nose, since the aesthetic goal is often a reduction in size, which may lead to nasal airway narrowing. Many surgeons today are incorporating techniques to their cosmetic nasal procedures to also strive to improve function. This commonly includes addressing causes of nasal obstruction like narrow internal nasal valves and inferior turbinate hypertrophy. Common anatomic causes of nasal obstruction include deviated nasal septum, nasal valve collapse, and turbinate hypertrophy. Regarding the inferior turbinates, several conditions can result in hypertrophy with resultant obstruction, including anatomic variation in size, infectious causes like chronic rhinitis, and allergic and vasomotor rhinitis. It has been found that chronic inflammation of the nasal mucosa leads to increased deposition of collagen and remodeling of bone, resulting in turbinate hypertrophy. Additionally, septal deviation can lead to compensatory hypertrophy of the inferior turbinate in the more patent nasal cavity.

Since the late 1800s, surgery to address nasal obstruction caused by the turbinates has been performed commonly by otolaryngologists. Early surgical approaches involved near total or total resection of the inferior turbinates. Turbinate resection was fraught with complications including bleeding, excessive crusting, and atrophic rhinitis. Additionally, there are concerns about turbulent, nonphysiologic airflow in the nose. Due to these complications, turbinate reduction procedures that maintain the physiologic ­function of the turbinates are now advocated.

The inferior turbinate is composed of a thin sheet of bone, submucosa, and overlying mucosal epithelium (see Fig. 12.1 ). More recent techniques for reduction of the tissue involve either partial resection, outfracture, laser reduction, radiofrequency reduction, coblation, microdebridement, or a combination of these to improve the nasal airway.

The Indications

Turbinate reduction can be performed to address chronic nasal congestion/obstruction in patients with moderate to severe turbinate hypertrophy that is causing narrowing or complete obstruction of the nasal airway.

The Surgery