Conservative turbinate reduction with or without microdebrider?

Question

I suffer of great dryness in my nose, but I am congested at the same time; I've decided to go ahead with turbinate reduction. I read that the procedure with a microdebrider is the most conservative. However, my surgeon will do a procedure of outfracture and will remove only the bony part of the turbinate, without using a microdebrider. This sounds like a conservative procedure as well. Is this procedure as conservative as using a microdebrider or the mucosa scarring will be larger?

Toby Mayer, MD · Answer

I feel you need to have a second opinion as to the cause of your dryness. Conservative turbinate reduction may or may not help you as there are other causes that may be present that give you the same problems. See a very experienced rhinoplasty surgeon as medication may be more indicated then surgery.

Summit Kundaria, MD · Answer

exnose,
Thanks for your question.  The inferior turbinates have a hearty submucosa, which is the layer beneath the lining, and some people have a very prominent bone in their turbinates.  You can actually use a microdebrider to remove both bone and tissue.  An antiquated technique involves simply cutting the turbinates off, but this is antiquated for a reason - turbinates actually have a function in your nasal airway resistance and humidification.  The proposed technique of your surgeon appears sound, with a partial removal of bone and out fracture to improve your nasal airway.  Personally, I have seen some surgeons do this and others use a microdebrider and leave the bone alone, and all patients seem to do reasonably well as long as the medical management is good post-op.  For patients with turbinate hypertrophy in the setting of allergies, I prefer to have them on nasal steroids to keep the soft tissue under control, as you can have regrowth of the turbinate tissue even after an aggressive removal if this is not done.  Unless your surgeon wants to cut off a large portion of your turbinates with the mucosa attached, I do not think that you need to worry about the mucosal preservation from one technique to another, as it sounds like your surgeon intends to remove the bone after isolating it from the soft tissue.  If this is not the case, and your surgeon wants to cut off the front parts of your turbinates, then I personally would look for another surgeon, though I have not examined you.

Victor Chung, MD · Answer

The turbinates are structures in the nose that help regulate humidity and airflow in the nose. When they are enlarged by chronic irritation like allergies they can contribute to nasal obstruction (blocked breathing). Aggressive turbinate reduction can cause more problems than help. Conservative turbinate reduction (mucosa-sparing) techniques remove tissue or bone without damaging the covering skin (mucosa) to avoid mucosal scarring. This can be performed by microdebrider, radiofrequency ablation, or meticulous surgical technique with similar results. It's important to examine the whole nose: evaluate for medical conditions, septal deviation, sinus disease, and nasal valve compromise for safe and happy result. Safety comes first.

Fred J. Bressler, MD, FACS · Answer

Outfracture of the turbinates preserves all of the existing turbinate mucosa and function. This is far more conservative than a turbinate reduction with a microdebrider. Your question raises several concerns however. Do you have an understanding or explanation about the great dryness you have in your nose? Topical therapy or systemic medical conditions maybe contributing to your debilitating symptom and should be addressed before considering turbinate surgery. Congestion vs nasal obstruction also needs to be understood, i.e. if you have nasal valve collapse, turbinate procedure will not completely help your nasal breathing. Hope this answer helps.

Conservative turbinate reduction with or without microdebrider?

Answers (4)

Answer: Turbinate Considerations

Answer: Turbinate Considerations

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Conservative turbinate reduction with or without microdebrider?

Answers (4)

Answer: Turbinate Considerations

Answer: Turbinate Considerations

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Everything you need to know about Rhinoplasty

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