Turbinate Surgery Procedure

An operation called a Turbinectomy or turbinate surgery is frequently done at the same time as a Septoplasty. Turbinate surgery is a minor procedure involves carefully trimming and thereby reducing the soft fleshy swellings of the inner sides of the nasal passages. It improves nasal breathing by reducing resistance since the cross-sectional area of the nasal channel is increased.

Role of the Turbinate

Your nose is the guardian of the respiratory tract. The visible, external part of your nose is only the casing for more complex apparatus. Three-quarters of the nasal channel is hidden behind your nose. This channel extends horizontally backwards to the very center of your head. There, at a 90 degree angle, it meets the top of your throat. At the root of your nose between the eyes are the nerves that enable you to smell. The area just inside your nostrils is the smallest cross-sectional area of your entire respiratory tract. It acts as the valve of your breathing. Two thirds of the resistance to airflow is found over this short segment of about an inch in length. Round areas of flesh, called turbinates, are located on the side walls of your nasal channels. There are 3 on each side and are found on the outer wall of your nasal cavity. They are shaped like a hot dog and are stacked one on each other.  Please click on the following to read more about turbinates http://en.wikipedia.org/wiki/Nasal_concha The largest is the most inferior. This turbinate is very, very vascular, with large blood vessels filling their interior. These blood vessels are able to swelling and shrink. In most people, at any given time, one turbinate is congested while in the opposite nasal channel the other is decongested. This causes most of your breathing to be through the side of your nose with the decongested turbinate, while the other side is blocked by the swollen turbinate and is at rest. After a several minutes to a few hours it switches and the open decongested nostril becomes congested and stuffy. The changeover takes less than a minute to happen. Most people are unaware of this cycle because the overall resistance to breathing remains unchanged. This cyclic activity is regulated by your brain. Please click on the following to read more about the nasal cycle. http://en.wikipedia.org/wiki/Nasal_cycle  Sometimes the nervous control of the turbinates is abnormal and results in blocked and uncomfortable breathing. A ‘cold’ in the nose or hay fever are two other very common causes for your turbinates to be swollen. At other times a deviated septum interferes with this cycle by blocking the breathing regardless whether the turbinate on the narrowed side is swollen or decongested. Your turbinates help prepare the air for your body. They act as a humidifier of the air you breathe in. Regardless of the outside humidity, by the time air has reached the back of your nose it has become almost completely saturated with water. It’s an amazing feat. Furthermore your turbinates warm the air to body temperature during this short passage. They also clean the air of pollution, dust and dirt. The vast majority of air flows horizontally backwards to where the end of the nose and the top of your throat meet. As it flows along, the air moves across three mounds of flesh inside the nose which warm, humidify and clean the air. These fleshy swellings are the turbinates and they look and act like the fins of a radiator. The very front of the largest and lowest turbinate controls the valve of your nose.

Turbinate Surgery

The turbinates can be reduced in several ways. They can be bent towards the inside wall of the nasal cavity thereby enlarging the airspace. This is called ‘out fracturing’ and is the least invasive means of altering the turbinates. They can also be cauterized or ‘burnt’. This causes the cauterized area to shrink as it heals and scars down. They can be frozen by using a probe the size of a pencil to shrink the turbinate. This is called Cryotherapy and can be done awake under local anesthesia. Finally a portion of the front of the turbinate can be amputated or cut away. This is the most aggressive turbinate surgery and requires a general anesthetic. When performing turbinate surgery, it is important for the surgeon to avoid  the “empty nose syndrome” by not over-trimming these soft fleshy swellings. This is one of the reasons surgical experience is so important in knowing the right amount to excise. Not taking enough of the front of the turbinate will reduce the improvement or even result in no improvement, while being too aggressive and removing too much will increase the risk of permanent issues like crusting and dryness.

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