There are three pairs of turbinates that originate on the lateral walls of the nasal cavity inside the nose. When the inferior turbinates (the lowest pair) are enlarged due to a condition such as environmental allergies, they are a common cause of nasal obstruction. Reducing the size of the inferior turbinates improves nasal blockage because this creates more space for breathing through the nose. Inferior turbinate reduction surgery can be accomplished with a variety of techniques; the most commonly used are submucous resection and radiofrequency reduction. When done in the operating room, these reduction procedures can be combined with a procedure called outfracture, in which the inferior turbinates are moved towards the side of the nose (opening up the space for breathing a little more) by breaking the thin bone that is inside the turbinate itself.
What are different types of turbinate reduction procedures?
Submucous resection of the inferior turbinates is performed in the operating room under general anesthesia. It is usually performed in combination with other procedures. It involves make a small cut in the lining of the inferior turbinates and lifting the lining off the thin bone that forms the structural support of the inferior turbinate. By removing part of this bone and allowing the healing process to shrink the lining of the turbinate, the nasal passage increases in size.
Radiofrequency inferior turbinate reduction is typically performed in the office without general anesthesia or sedation. A specially-designed probe with a needle at the end is placed into the turbinate, and radiofrequency energy is delivered to heat the tissues beneath the surface in a controlled way. By heating the tissues, damage is created, and the healing process reduces the size of the inferior turbinates. The entire procedure typically takes approximately 10 minutes, although more time is required to numb the area with local anesthesia. The procedures typically have little to no pain during the healing period, and the risks are relatively low. Often a single treatment session is effective, but many patients do require more than one session.
Frontal view of the face
Side view of the structures of the nose and mouth
In the turbinate radiofrequency procedure, the probe in placed into inferior turbinate to deliver treatment
After inferior turbinate surgery, healing causes shrinkage of the tissues, creating more space for breathing
The following video presents a discussion of nasal procedures, including turbinate surgery:
The inferior turbinates have an excellent blood supply. While many steps are taken to minimize the risk of bleeding after surgery, there is a chance that it can occur. A major factor in preventing serious bleeding is to avoid the use of aspirin, NSAIDs (such as ibuprofen, Advil®, Motrin®, naproxen, or Aleve®), vitamin supplements, or herbal medications for at least two weeks before and after surgery. Minor bleeding should be expected, but the amount of bleeding can potentially be significant or life-threatening.
Enlargement of the inferior turbinates in the future
There is usually an underlying reason why a person develops enlarged inferior turbinates, and environmental allergies are just one example of a potential cause. These procedures reduce the size of the inferior turbinates, but over time they will tend to become enlarged again because the procedure does not treat the underlying cause of turbinate enlargement. Nasal sprays can be effective in maintaining the smaller size, but additional procedures (including a repeat of the same procedure) may be required in the future.
Dryness of the nose and crusting
These problems are usually temporary, but they may be permanent.
Change in the sense of smell
Any surgery inside the nose can occasionally cause alterations in the sense of smell. Your sense of smell may return, although changes can be permanent.
Need for additional procedures
There is a chance that inferior turbinate surgery will not be effective in accomplishing the goals of surgery. Another procedure—either performed on the inferior turbinates or on another area—may be necessary to provide the desired relief of nasal obstruction.
There should only be mild discomfort after turbinate surgery unless other procedures are performed at the same time. Use acetaminophen (Tylenol) for pain control. Avoid aspirin, NSAIDs (such as ibuprofen, Advil®, Motrin®, naproxen, or Aleve®), vitamin supplements, or herbal medications for at least two weeks because they can increase your risk of bleeding after surgery. Contact your doctor immediately if any significant pain should occur.
Nasal saline two sprays each nostril four times a day for three weeks
Nasal saline serves two purposes. It gently washes away all loose debris such as dried blood to keep the nose clean during the healing process, and it also accelerates healing by maintaining a moist environment in the nose.
Nasal decongestant (such as oxymetazoline or Afrin® spray) one spray each nostril at bedtime for one or two days and as needed to control bleeding
A decongestant decreases the amount of swelling in the nose and can keep the nasal passages open during the healing phase. Because these sprays cannot be used for more than a few days without causing their own set of problems, we recommend that patients combine regular use for one or two days at bedtime, with additional use as needed to control any bleeding from the nose. In case of bleeding, sit down and spray two sprays of this medication in the side that is bleeding. Repeat the sprays up to five times (two sprays at a time) every five minutes until the bleeding stops or slows substantially. This is more sprays than the packaging recommends, but it is OK because you are using the medication for bleeding, not the typical use. Because bleeding after turbiante surgery is most likely coming from the inferior turbinate (an area farther back than the outside soft tissues of your nose), pinching your nose may not be helpful. Tilt your head forward slightly so that the blood does not run down the back of your throat, although try to let the medication spray stay in your nose.
Minimize strenuous physical activity for two weeks
Patients are encouraged to resume most normal daytime activities if they have undergone isolated turbinate surgery. At a minimum, they should walk at least three times a day, starting the day after surgery. Walking and spending more time out of bed (walking or in a chair) rather than in bed are helpful because they reduce the risks of developing pneumonia or blood clots in the legs. However, they should avoid strenuous activity because it typically raises heart rate and blood pressure. For this reason, it can increase swelling or cause bleeding to start.
For any emergencies, please call 911. For other questions, please contact Dr. Kezirian at [email protected]. If you would like to speak with someone, please call the Call Center at 323-442-5790 and ask to speak to Dr. Kezirian or whomever is answering calls for his patients.