Radiofrequency Thermal Ablation versus Bipolar Electrocautery for the Treatment of Inferior Turbinate Hypertrophy: Comparison of Efficacy and Postoperative Morbidity

Inferior Turbinate Hypertrophy: A Comparison of Surgical Techniques

Introduction Nasal obstruction is one of the most frequently reported symptoms in clinical practice. The second most common cause of nasal obstruction is inferior turbinate hypertrophy, a nasal pathology for which surgical treatment is often required. This study aims to determine the most effective surgical method in patients with inferior turbinate hypertrophy (ITH). Materials and methods The study was performed from September 2018 to October 2019 in the Otolaryngology-Head and Neck Surgery Department of the Evangelismos Hospital of Athens. The study population comprised 205 patients that underwent surgery and were monitored in the hospital. Radiofrequency ablation (RFA) was the method used in 73 patients, 68 patients were treated with the microdebrider-assisted turbinoplasty (MAT), and the remaining 64 patients were operated on using electrocautery (EC). Following surgery, postoperative complications were assessed and quantified. Results Overall, 205 patients underwent surgery. The first group (n=73) was operated on using radiofrequency ablation and had a complication rate of 30.1%. Out of 73 patients, 51 recovered without complications. The remaining 22 had complications, consisting of 16 patients with bleeding and six with postnasal drip. The second group (n=68) was treated using the microdebrider method. The complication rate was 26.5%, where 50 patients did not present with any symptoms post-operatively and 18 exhibited symptoms. Specifically, postnasal drip was more prevalent with this method as all 18 patients showed postnasal drip as their complication. The third group (n=64) was treated with electrocautery. Patients in this group had the most complications (n=24), 16 were attributed to postnasal drip and eight to infections, treated promptly with oral antibiotics. The complication rate using this method was 37.5%. Conclusion In our study, the microdebrider-assisted turbinoplasty offered the lowest complication rate, followed by radiofrequency ablation and electrocautery. However, all three methods managed to alleviate the nasal obstruction and treat inferior turbinate hypertrophy. More research is needed as a lack of consensus remains regarding the optimal surgical technique for lower turbinate hypertrophy.

[Nasal turbinate surgery]

The nose forms the first 8 cm of the upper respiratory tract and is responsible for cleansing, humidification, and temperature control of the supplied air. This is also referred to as conditioning. The nasal valve region, formed by the head of the lower nasal concha, portions of the cartilaginous septum, and the upper lateral cartilage, is responsible for diffusing and accelerating the respiratory airflow. Prerequisite are regular mucociliary clearance and sufficient air passage. Hypertrophy of the lower nasal turbinate is one of the most common causes of symptomatic nasal congestion. In unclear cases, rhinometric procedures are available. In addition to conservative therapy of allergic or vasomotor rhinitis by specific immunotherapy or topical corticoids, numerous interventional procedures are available to reduce conchal tissue. All modern methods have a high degree of protection of the respiratory mucosa in common.

Intravascular application of electrocautery in a rabbit model of abdominal aortic endarterectomy

Effective therapies for preventing perioperative complications such as thrombosis and inflammation after coronary endarterectomy (CE) are lacking. Electrocoagulation electrotomes have been routinely used in surgery for their cutting, clotting, and hemostatic properties. As strong flattening tools, their electrocautery function may prevent mechanical intimal-adventitial injury to arterial circulation and attenuate stenosis. The present study investigated the effects of intravascular application of electrocautery on ameliorating inflammation and thrombosis in a rabbit model of abdominal aortic endarterectomy. New Zealand rabbits were randomly divided into the sham, control (endarterectomy), and study (endarterectomy + electrocautery) groups with 10 in each group. Abdominal aortas were partially blocked and intima was removed. Electrocautery was performed with an electrocoagulation electrotome through the entire blocked vessel lumen. Vascular ultrasound parameters, molecular biological and histological characteristics of the abdominal aorta including vascular diameter, blood flow velocity, serum interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) levels, and apoptosis rate of vascular endothelial cells (ECs) were evaluated postoperatively by vascular Doppler ultrasound, ELISA, real-time RT-PCR, flow cytometry, and immunofluorescence at various time points. Compared with the endarterectomy + electrocautery group, the isolated endarterectomy group had significantly increased levels and gene expression of TNF-α and IL-6 (P<0.05), and rates of apoptosis of vascular ECs (P<0.05), with gradual vascular stenosis and decreased blood flow velocity. In conclusion, intravascular application of electrocautery has favorable short-term effects on the abdominal aorta and can reduce inflammation in a rabbit model of abdominal aorta endarterectomy. Long-term anti-inflammatory and anti-thrombotic effects on arterial remodeling and the clinical value of electrocautery in CE remain to be determined.