Rhino/Septoplasty without turbinate reduction?

Question

Hello, I am getting close to booking my surgery and my doctor is going to perform a rhino/septoplasty with turbinate reduction. However, I just came across some information about Empty Nose Syndrome which left me completely terrified of having this procedure. Can I have the surgery without him removing part of my turbinates? It's the look of my nose that bothers me the most, not the breathing aspect. Thanks so much for your time!

Ivan Wayne, MD · Answer

Hello, and thank your for your question. In the 20 years I have been doing surgery on noses I have rarely seen empty nose syndrome-the few patients I have encountered with that problem had very aggressive removal of essentially all of their inferior turbinates (this was done by other doctorsNasal turbinates  provide many functions for the nose. They moisturize the air we breath. They filter out many particles from the air we breath. They also provide a sense of nasal resistance and provide information to the brain that is telling us how our breathing is. I think this is where taking out too much turbinate tissue can cause problems-even though our nose is wide open without the turbinate telling us that air is flowing through that can be sensation of resistance-this is the "empty nose syndrome". Where I practice in Oklahoma-we have a dry climate and we are very careful with surgery on turbinates. I typically do not remove any tissue from turbinates during a rhinoplasty and if they are blocking they can be treated successfully by repositioning them laterally. Every patient is treated for their individual goals with respect for their nasal anatomy. A frank discussion with your surgeon about what they are planning to do to your turbinates is essential.Good luck and I hope this helps you.Dr. Wayne

David C. Yao, MD, FACS · Answer

Thank you for asking. Empty nose syndrome is an airway condition after the lower (sometimes middle) turbinates are excessively removed. It is much more uncommonly done today. Surgeons from Rochester, MN have described this. Talk with your surgeon about your needs- chances are a reduction is not a total removal. Best wishes

Tanveer Janjua, MD · Answer

Empty nose syndrome is uncommon.  It usually happens if the turbinates have been removed.  Most surgeons do not remove the turbinates during the turbinectomy but only move them to the side or reduce its size internally.  That is a safe procedure.  You should discuss this with you surgeon and not be afraid.RegardsDr. J

Richard Mark Winters, MD · Answer

Unfortunately, much of the rhinoplasty surgery (functional and/or cosmetic) performed and taught in the 1970's and 1980's was destructive to normal anatomic structures....over resection of supporting and functional structures led to bad cosmetic results and poor functional outcomes.Modern day experts in rhinoplasty surgery who devote a significant amount of their practice to the discipline of nasal surgery generally adhere to 'constructive' principles with meticulous attention to anatomical detail...in this way, cosmetic results are much more predictable and shouldn't come at the expense of function.... in addition, the correction of many functional issues will be synergistic with aesthetic goals.... older methods of turbinate resection have been replaced by radiofrequency ablation and minimally invasive meansgood luck

Demetrio J. Aguila III, MD, FACS · Answer

Thank you for your question.Nasal surgery to address nasal obstruction and difficulty breathing through the nose is a complex and multi-layered set of procedures that work together to correct various parts of your nasal airway in order to improve airflow.  In order to properly improve nasal airflow, it is necessary to first understand the anatomy and physiology of the nose, and then treat each portion of that anatomy and physiology that are functioning suboptimally.  In the right patient, a turbinate reduction can be a transformative procedure that helps patients breathe like never before.Certain types of turbinate reductions have been more associated with empty nose syndrome than others, and other types of turbinate reduction have been associated with only temporary results.  The "Gold Standard" of turbinate reduction is the submucous resection of the inferior turbinates.  This prevents empty nose syndrome while also yielding long-lasting results.I suggest that you ask your surgeon these questions specifically and find out how he plans to avoid this potential complication.  Of course, you're also entitled to a second opinion if you need more reassurance - you deserve to be happy with your surgical plan, as well as the team you've chosen to carry it out.Best wishes.

William Portuese, MD · Answer

It is very important to removed a conservative on amount of tissue  with turbinate reduction, to avoid empty nose syndrome. The decision to perform turbinate surgery is made at the time of examination /consultation when the turbinates do not respond well to medical management, and they are significantly enlarged creating nasal obstruction in addition to a deviated nasal septum. Rhinoplasty is also one of the more difficult procedure to perform correctly in the entire field of plastic surgery, so choose your functional and cosmetic nasal surgeon  wisely based on experience

Harrison C. Putman III, MD (retired) · Answer

Dear ruby, you have obviously done your homework! Many types of turbinate reduction other than resection are commonly performed for excessive hypertrophy of the inferior turbinates. You would be well advised to discuss the other options with your surgeon pre operatively, especially if you do not have nasal airway obstruction at present. Often times there is compensatory hypertrophy of one side only with a deviated septum, and it may be that this should be addressed at the time of surgery. Please seek clarification from your surgeon about this as well. Good luck!

Jon A. Perlman, MD (retired) · Answer

It's unclear to me why your surgeon is suggesting a turbinate resection if you are not symptomatic or have significant turbinate enlargement. When done resection of the turbinates can and should be done conservatively if a good indication is present.  Lesser treatment would include outfracture and crush of the aircells contained within the turbinates without resection.Discuss options carefully with your surgeon and although you should be aware of potential risks most people do well with all of the procedures described above.  Good luck and enjoy your results.Dr. Perlman

Rhino/Septoplasty without turbinate reduction?

Answers (8)

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