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Shetty SR, Al-Bayatti SW, Al Kawas S, Al-Rawi NH, Kamath V, Shetty R, Shetty S, Desai V, David L. A study on the association between the inferior nasal turbinate volume and the maxillary sinus mucosal lining using cone beam tomography. Heliyon 2022; 8:e09190. [PMID: 35368549 PMCID: PMC8968633 DOI: 10.1016/j.heliyon.2022.e09190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/12/2022] [Accepted: 03/21/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives The volume of the inferior turbinates (IT) and the lining of the maxillary sinuses are important parameters when assessing sino-nasal diseases. However, no radiographic studies have investigated the correlation between these parameters. The present study was conducted to analyze the association between IT volumes and thickness of maxillary sinus mucosal lining. Materials and methods A retrospective evaluation of the cone-beam computed tomography (CBCT) scans of 100 adult subjects was carried out by two radiologists. The scans were assigned to two groups (Group 1 & 2) based on the radiographic evidence of maxillary sinus lining in the CBCT scans. Group 1 consisted of 50 CBCT scans of subjects with no evidence of maxillary sinus mucosal lining, whereas Group 2 consisted of 50 subjects with evidence of maxillary sinus mucosal lining. The scans in the Group 2 were further sub-classified into five categories, based on the thickness of the maxillary sinus mucosal lining. Vesalius 3D software was used to evaluate the total volume of inferior nasal turbinates by the two radiologists and a mean volume was obtained for each study subject. Results The intraclass correlation coefficient (ICC) between the volumetric estimations performed by the two radiologist was 0.87. Analysis of the results revealed that there was no significant gender-based difference (Group 1, P = 0.67 and Group 2, P = 0.95) in the total turbinate volume in either of the study groups. The total turbinate volume did not show any significant correlation (Group 1, r = 0.24 and Group 2, r = 0.12) with the age. There was a significant increase (P = 0.001) in the total turbinate volume of the subjects in Group 2 compared to Group 1. Regression analysis revealed that the thickness of sinus lining correlated significantly (P = 0.001) with the total turbinate volume. Conclusion An increase in the total turbinate volume has been associated with an increase in the thickness of the maxillary sinus mucosal lining. The data from this study will be useful for post-operative follow-up of inferior turbinates and maxillary sinus lining after the turbinate volume reduction procedures.
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Affiliation(s)
- Shishir Ram Shetty
- College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | | | - Sausan Al Kawas
- College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | | | | | | | - Sunaina Shetty
- College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Vijay Desai
- College of Dentistry, Ajman University, Ajman, United Arab Emirates
| | - Leena David
- College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
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Bozan A, Eriş HN, Dizdar D, Göde S, Taşdelen B, Alpay HC. Effects of turbinoplasty versus outfracture and bipolar cautery on the compensatory inferior turbinate hypertrophy in septoplasty patients. Braz J Otorhinolaryngol 2018; 85:565-570. [PMID: 29891422 PMCID: PMC9443047 DOI: 10.1016/j.bjorl.2018.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/14/2018] [Accepted: 04/17/2018] [Indexed: 12/03/2022] Open
Abstract
Introduction The most common cause of septoplasty failure is inferior turbinate hypertrophy that is not treated properly. Several techniques have been described to date: total or partial turbinectomy, submucosal resection (surgical or with a microdebrider), with turbinate outfracture being some of those. Objective In this study, we compared the pre- and postoperative lower turbinate volumes using computed tomography in patients who had undergone septoplasty and compensatory lower turbinate turbinoplasty with those treated with outfracture and bipolar cauterization. Methods This retrospective study enrolled 66 patients (37 men, 29 women) who were admitted to our otorhinolaryngology clinic between 2010 and 2017 because of nasal obstruction and who were operated on for nasal septum deviation. The patients who underwent turbinoplasty due to compensatory lower turbinate hypertrophy were the turbinoplasty group; Outfracture and bipolar cauterization were separated as the out fracture group. Compensatory lower turbinate volumes of all patients participating in the study (mean age 34.0 ± 12.4 years, range 17–61 years) were assessed by preoperative and postoperative 2 month coronal and axial plane paranasal computed tomography. Results The transverse and longitudinal dimensions of the postoperative turbinoplasty group were significantly lower than those of the out-fracture group (p = 0.004). In both groups the lower turbinate volumes were significantly decreased (p = 0.002, p < 0.001 in order). The postoperative volume of the turbinate on the deviated side of the patients was significantly increased: tubinoplasty group (p = 0.033). Conclusion Both turbinoplasty and outfracture are effective volume-reduction techniques. However, the turbinoplasty method results in more reduction of the lower turbinate volume than outfracture and bipolar cauterization.
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Affiliation(s)
- Aykut Bozan
- Istanbul Kemerburgaz University, Medical Faculty, Department of Otorhinolaryngology, Tarsus, Turkey
| | | | - Denizhan Dizdar
- Istanbul Kemerburgaz University, Medical Faculty, Department of Otorhinolaryngology, Tarsus, Turkey.
| | - Sercan Göde
- Ege University, Medical Faculty, Department of Otorhinolaryngology, İzmir, Turkey
| | - Bahar Taşdelen
- Mersin University, Medical Faculty, Biostatistics, Mersin, Turkey
| | - Hayrettin Cengiz Alpay
- Istanbul Kemerburgaz University, Medical Faculty, Department of Otorhinolaryngology, Tarsus, Turkey
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Akagün F, İmamoğlu M, Çobanoğlu HB, Ural A. Comparison of Radiofrequency Thermal Ablation and Microdebrider-Assisted Turbinoplasty in Inferior Turbinate Hypertrophy: A Prospective, Randomized, and Clinical Study. Turk Arch Otorhinolaryngol 2016; 54:118-123. [PMID: 29392030 DOI: 10.5152/tao.2016.1747] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 09/07/2016] [Indexed: 11/22/2022] Open
Abstract
Objective To compare the effectiveness of radiofrequency thermal ablation with those of microdebrider-assisted turbinoplasty, we designed a prospective, randomized clinical study. Methods Forty patients suffering from nasal obstruction due to bilateral inferior turbinate hypertrophy were enrolled. Half of the patients were operated by radiofrequency thermal ablation, while the other half underwent microdebrider-assisted turbinoplasty. The outcomes of both techniques were compared in terms of symptomatology, nasal patency, and mucociliary transport. Results A statistically significant difference existed between the two groups with respect to nasal obstruction and the frequency of obstruction at the first post-operative week and first and third post-operative months (p<0.05). Rhinomanometry detected a significant decrease in nasal resistance values in both surgical groups compared to the preoperative values. The mucociliary transport time was significantly prolonged in the first postoperative week and first postoperative month in microdebrider-assisted inferior turbinoplasty group. Conclusion Both radiofrequency thermal ablation and microdebrider-assisted turbinoplasty are effective techniques for treating inferior turbinate hypertrophy. The treatment modality should be individually determined, and parameters such as tissue healing, volume reduction, and mucociliary activity must be taken into account.
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Affiliation(s)
- Fatih Akagün
- Department of Otorhinolaryngology, Giresun State Hospital, Giresun, Turkey
| | - Mehmet İmamoğlu
- Department of Otorhinolaryngology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | | | - Ahmet Ural
- Department of Otorhinolaryngology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
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Kim SJ, Kim HT, Park YH, Kim JY, Bae JH. Coblation nasal septal swell body reduction for treatment of nasal obstruction: a preliminary report. Eur Arch Otorhinolaryngol 2016; 273:2575-8. [PMID: 26912145 DOI: 10.1007/s00405-016-3946-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 02/22/2016] [Indexed: 12/12/2022]
Abstract
In this paper, we present the results of coblation nasal septal swell body (NSB) reduction for the treatment of nasal obstruction in patients with abnormally thickened NSB. The study design was a retrospective clinical series conducted at a single tertiary medical center. Eight patients underwent coblation NSB reduction. Pre-operative and post-operative nasal functions were evaluated by acoustic rhinometry and subjective symptom scales. We also analyzed pre-operative CT scan images and nasal endoscopic findings. The mean maximal NSB width was 16.4 ± 2.2 mm on pre-operative coronal CT scan images. The mean visual analog scale score for nasal obstruction was decreased from preoperative 7.63 ± 0.99 points to 3.88 ± 0.92 points (postoperative 3 months), 4.16 ± 0.78 points (postoperative 6 months), and 4.63 ± 0.69 points (postoperative 1 year). Six out of the eight patients were satisfied with the clinical outcome at 1 year after the procedure. To the best of our knowledge, coblation NSB reduction has not yet been reported in the medical literature. Our results show that it can be an effective treatment modality for nasal valve narrowing in patients with abnormally thickened NSB.
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Affiliation(s)
- So Jeong Kim
- Department of Otolaryngology-Head and Neck Surgery, Ewha Womans University School of Medicine, 911-1 Mok-Dong, Yang Cheon-Ku, Seoul, 158-710, Korea
| | - Hee Tae Kim
- Department of Otolaryngology-Head and Neck Surgery, Ewha Womans University School of Medicine, 911-1 Mok-Dong, Yang Cheon-Ku, Seoul, 158-710, Korea
| | - Yun Hwi Park
- Department of Otolaryngology-Head and Neck Surgery, Ewha Womans University School of Medicine, 911-1 Mok-Dong, Yang Cheon-Ku, Seoul, 158-710, Korea
| | - Ju Yeon Kim
- Department of Otolaryngology-Head and Neck Surgery, Ewha Womans University School of Medicine, 911-1 Mok-Dong, Yang Cheon-Ku, Seoul, 158-710, Korea
| | - Jung Ho Bae
- Department of Otolaryngology-Head and Neck Surgery, Ewha Womans University School of Medicine, 911-1 Mok-Dong, Yang Cheon-Ku, Seoul, 158-710, Korea.
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Gode S, Turhal G, Kismali E, Ozturk K, Midilli R. A novel method for comparison of tissue fibrosis after inferior turbinate surgery: ultrasound elastography. Am J Rhinol Allergy 2015; 29:e33-6. [PMID: 25590315 DOI: 10.2500/ajra.2015.29.4145] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Ultrasound (US) elastography has been widely used for thyroid, liver, and lymph nodes as a research tool in the current medical practice. It has been described in the inferior turbinates and validated as a reliable, reproducible, noninvasive, and objective method that can detect the fibrosis-related tissue strain. There is no previous study that investigated the amount of fibrosis induced by radiofrequency and bipolar electrocautery in the inferior turbinates in a noninvasive and objective manner. The aim of this study was to assess the amount of inferior turbinate soft tissue fibrosis that was induced by radiofrequency ablation (RFA) and submucosal bipolar diathermy (SBD) by US elastography. METHODS Thirty-eight inferior turbinates of 19 patients were included. RFA was applied to 18 inferior turbinates (group 1) and SBD was applied to 20 inferior turbinates (group 2). US elastography and visual analog scale (VAS) assessments were performed on all patients preoperatively and 6 months postoperatively. RESULTS Preoperative mean US elastography scores in groups 1 and 2 were 2.55 ± 0.78 m/s and 2.56 ± 0.49 m/s, respectively (p < 0.05). Postoperative mean US elastography scores in groups 1 and 2 were 2.91 ± 1.03 m/s and 3.41 ± 0.86 m/s, respectively (p < 0.05). Preoperative mean VAS scores in groups 1 and 2 were 2.78 ± 0.94 and 2.50 ± 1.15, respectively. Postoperative mean VAS scores in groups 1 and 2 were 6.61 ± 1.61 and 6.10 ± 1.4, respectively (p < 0.05). Correlation of US elastography and VAS scores was insignificant (p > 0.05). CONCLUSION Both RFA and SBD of the inferior turbinates were effective in inducing scar tissue and, eventually, fibrosis in the soft tissue of inferior turbinates. Cauterization has been found to cause significantly higher amounts of fibrosis than radiofrequency; however, it did not reflect the comparable clinical outcome. This is the first study that objectively and noninvasively evaluates the targeted tissue fibrosis of the inferior turbinate surgeries by the novel inferior turbinate US elastography.
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Affiliation(s)
- Sercan Gode
- Department of Otolaryngology, Faculty of Medicine, Ege University, Izmir, Turkey
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Acevedo JL, Camacho M, Brietzke SE. Radiofrequency Ablation Turbinoplasty versus Microdebrider-Assisted Turbinoplasty: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2015; 153:951-6. [PMID: 26450750 DOI: 10.1177/0194599815607211] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 08/31/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To critically review published literature for treatment-related outcomes for bilateral inferior turbinate reduction (IFTR) via either microdebrider-assisted turbinoplasty (MAT) or radiofrequency turbinoplasty. The primary outcomes were relief of nasal obstruction according to visual analog scale and nasal airflow, volume, and resistance measures based on acoustic rhinomanometry. DATA SOURCES MEDLINE, EMBASE, The Cochrane Catalog, and CINAHL. REVIEW METHODS The databases were searched with the terms "turbinoplasty" and "turbinate reduction." Inclusion criteria were English language, human subjects, and studies specifically relating to IFTR with radiofrequency turbinoplasty or MAT. Exclusion criteria were pediatric patients and concurrent nasal procedures. Results were tabulated, and the data were analyzed per random effects modeling. Subgroup analysis and quality assessment were also performed. RESULTS A total of 976 articles were initially identified, with 26 meeting the inclusion/exclusion criteria. Random effects modeling demonstrated a significant improvement after IFTR, as measured with the visual analog scale (4.26-point improvement, 95% confidence interval [95% CI] = 3.32-5.20, P < .001, k = 21 studies, I(2) = 99%) and with acoustic rhinomanometry measurements of volume (2.43-cm(3) improvement, 95% CI = 0.48-4.38, P = .015, k = 6 studies, I(2) = 99%), flow (203-mL/s improvement, 95% CI = 131-276, P < .001, k = 4 studies, I(2) = 99%), and resistance change (2.78-Pa/cm(3) improvement, 95% CI = 0.433-5.13, P = .020, k = 5 studies, I(2) = 99%). There was no difference in outcome by technique, allergic rhinitis, or quality score. The 2 highest-quality papers favored MAT. The median follow-up was 6 months. CONCLUSIONS IFTR produces a significant subjective and objective improvement in nasal airflow in the short term. This change does not appear to be related to the technique used for IFTR.
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Affiliation(s)
- Jason L Acevedo
- Reynolds Army Community Hospital, Fort Sill, Oklahoma, USA Uniformed Services University, Bethesda, Maryland, USA
| | | | - Scott E Brietzke
- Uniformed Services University, Bethesda, Maryland, USA Walter Reed National Military Medical Center, Bethesda, Maryland, USA
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Ercan C, Imre A, Pinar E, Erdoğan N, Umut Sakarya E, Oncel S. Comparison of submucosal resection and radiofrequency turbinate volume reduction for inferior turbinate hypertrophy: evaluation by magnetic resonance imaging. Indian J Otolaryngol Head Neck Surg 2013; 66:281-6. [PMID: 25032115 DOI: 10.1007/s12070-013-0696-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 11/25/2013] [Indexed: 01/13/2023] Open
Abstract
Inferior turbinate hypertrophy is a frequent cause of nasal airway obstruction and drastically impairs patients' quality of life. Surgical reduction of the inferior turbinates can be used for patients who did not respond to medical therapy. A number of studies have been performed to identify the most effective technique. The aim of this study was to compare the effectiveness of submucosal resection (SMR) and radiofrequency turbinate volume reduction (RFTVR) in patients with inferior turbinate hypertrophy. A prospective, randomized case-control study was conducted. Sixty patients with inferior turbinate hypertrophy refractory to medical therapy were prospectively and randomly assigned to two groups: SMR and RFTVR. A visual analog scale (VAS) and the nasal inspiratory peak flow (NPIF) were analyzed pre- and postoperatively at the first week and second month. Magnetic resonance imaging was performed pre- and postoperatively at the second month. The surgical outcomes were compared statistically using subjective and objective measures. Significant turbinate volume reduction was achieved in both the SMR and RFTVR groups. However, turbinate volume reduction was significantly greater in the SMR than in the RFTVR group at the second month postoperatively. NIPF and VAS scores were improved after both procedures at the second month postoperatively. Beside this, surgical outcomes were significantly better after SMR in terms of NIPF and VAS scores. In this study, we demonstrated that both SMR and RFTVR are effective for inferior turbinate hypertrophy. Turbinate volume reduction, improvement of subjective nasal obstruction symptoms, and NIPF after SMR were significantly superior to those after RFTVR.
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Affiliation(s)
- Can Ercan
- Department of Otorhinolaryngology-Head and Neck Surgery, Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Abdulkadir Imre
- Department of Otorhinolaryngology-Head and Neck Surgery, Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey ; 9200/1 Sk. No: 5 D:10 Camlıkent sitesi, Karabaglar, 35140 Izmir, Turkey
| | - Ercan Pinar
- Department of Otorhinolaryngology-Head and Neck Surgery, Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Nezahat Erdoğan
- Department of Radiology, Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - E Umut Sakarya
- Department of Otorhinolaryngology-Head and Neck Surgery, Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Semih Oncel
- Department of Otorhinolaryngology-Head and Neck Surgery, Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
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Aslan G. Postnasal drip due to inferior turbinate perforation after radiofrequency turbinate surgery: A case report. ALLERGY & RHINOLOGY 2013; 4:e17-20. [PMID: 23772320 PMCID: PMC3679561 DOI: 10.2500/ar.2013.4.0046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Management of inferior turbinate hypertrophy includes surgical options in case of failure with medical treatment and the main goal of turbinate surgery is to relieve the patient's symptoms of chronic nasal congestion while preserving mucosal surfaces with reduction of the submucosal and bony tissue. In this regard, radiofrequency volumetric tissue reduction has been a thermal technique associated with satisfactory results and fewer side effects. Historical detail on onset, timing, duration, and severity of symptoms and aggravating and relieving factors are important in the differential diagnosis of postnasal drip (PND). Here, we report development of intractable PND due to inferior turbinate perforation after radiofrequency turbinate surgery for the first time in the literature and the successful improvement via removal of pathological anatomic structure under nasal endoscopy–directed surgery in a 35-year-old female patient. The patient had a good functional outcome postoperatively with no further complications or signs of recurrence occurring, to date, within a postoperative follow-up period of 1 year.
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Affiliation(s)
- Gaffar Aslan
- Department of Otorhinolaryngology-Head and Neck Surgery, Istanbul Bilim University Faculty of Medicine, Istanbul, Turkey
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