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Turbinate reduction with complete preservation of mucosa and submucosa during rhinoplasty

Selektive submuköse Entfernung des Os turbinale bei funktionell-ästhetischer Rhinoplastik

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Abstract

Background

Turbinate surgery is an important adjunct to functional and cosmetic rhinoplasty. Many studies have analyzed the effects of various mucosal-sparing techniques, such as radiofrequency, laser, shaver, and others. These techniques, however, result in the destruction of the submucosal tissue of the turbinate. The goal of this study was to determine whether excellent functional outcome could be achieved with techniques sparing both the mucosa and submucosa from destruction when addressing the turbinates in rhinoplasty surgery.

Materials and methods

A prospective single-surgeon clinical study analyzing submucous resection of turbinate bone without destruction of the submucosa or mucosa in patients undergoing functional–esthetic rhinoplasty was performed. In all, 122 patients (47 men, 75 women, average age: 32.1 years, range: 16–69 years) were eligible for the study. The functional outcome was measured prospectively using the Nasal Obstruction Symptom Evaluation (NOSE) score. Occurrence of complications was documented.

Results

Of over 1000 surgical patients, 307 candidates fulfilled multiple selection criteria and were entered in a rhinoplasty database. The surveys sufficient for the present study were completed by 122 of 307 patients (39.7%), of whom 91 patients reported improvement, 14 patients reported no subjective change, and 12 patients reported minimal worsening of nasal breathing. Overall, postoperative function was excellent (preoperative vs. postoperative NOSE score 47.5 vs. 20.1, p < 0.001). A large proportion of patients reporting worsening of symptoms (50%) were diagnosed with decongestant nasal spray abuse. Specific complications such as bleeding, foul drainage, dryness, and crusting were not reported.

Conclusion

All function-bearing structures of the inferior nasal turbinates, mucosa, and submucosa can be fully preserved without impairment of functional outcome during rhinoplasty. The technique of selective submucous bone resection is as an excellent alternative for patients undergoing rhinoplasty for concomitant treatment or prevention of nasal obstruction.

Zusammenfassung

Hintergrund

Die Behandlung der Nasenmuscheln stellt einen wichtigen Aspekt der kombiniert funktionell-ästhetischen Rhinoplastik dar. Die Effekte schleimhautschonender Verfahren sind in vielen Studien eingehend untersucht worden. Diese Techniken resultieren in der Regel in einer Destruktion der Submukosa der Nasenmuscheln.

Ziel

Das Ziel der vorliegenden klinischen Single-Surgeon-Studie war zu analysieren, ob exzellente funktionelle Ergebnisse bei der Behandlung der Nasenmuscheln im Rahmen einer Rhinoplastik auch bei Schonung der Submukosa und Mukosa der Nasenmuscheln erzielbar sind.

Material und Methoden

Von über 1000 Kandidaten eigneten sich 307, welche die Einschlusskriterien erfüllten und deren Daten in eine Datenbank aufgenommen wurden. Bei 122 Patienten (47 Männer, 75 Frauen, Alter: 16–69, im Mittel 32,1 Jahre) konnten alle notwendigen Daten erhoben werden. Die funktionellen Ergebnisse wurden mittels einer deutschen Übersetzung des Fragebogens Nasal Obstruction Symptom Evaluation (NOSE) ermittelt.

Ergebnisse

Bei 91 Patienten wurde eine Verbesserung der Nasenatmung verzeichnet, bei 14 keine Veränderung und bei 12 Patienten eine Verschlechterung. Eine Rhinitis medicamentosa lag bei 50 % der Patienten mit Verschlechterung vor. Insgesamt war die Nasenatmung mit einer durchschnittlichen Verbesserung des NOSE-Scores von 47,5 präoperativ vs. 20,1 postoperativ (p < 0,001) exzellent. Komplikationen wie Blutung, übelriechendes Sekret, Trockenheit oder Krustenbildung wurden nicht beobachtet.

Schlussfolgerung

Die funktionstragenden Weichteilgewebe der Nasenmuscheln, Mukosa und Submukosa, können bei der Behandlung der Nasenmuscheln im Rahmen einer funktionell-ästhetischen Rhinoplastik komplett geschont werden. Die selektive submuköse Knochenresektion der unteren Nasenmuschel kann als exzellente alternative Methode bei der komplikationsarmen Behandlung der Nasenmuscheln angesehen werden.

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Acknowledgements

Dr. Achim Beule is acknowledged for providing the German translation of the NOSE questionnaire.

M. Rudes and H. G. Gassner were previously affiliated with the University of Regensburg. Data acquisition was from University of Regensburg, Germany.

Author information

Authors and Affiliations

  1. The Finesse Center for Facial Plastic Surgery/ENT, Froehliche-Tuerkenstraße 8, 93047, Regensburg, Germany

    M. Rudes & H. G. Gassner

  2. Department of Otorhinolaryngology and Head and Neck Surgery, University of Regensburg, Regensburg, Germany

    F. Schwan

  3. Department of Obstetrics and Gynecology, Brothers of Mercy Hospital, Schwandorf, Germany

    F. Klass

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  1. M. Rudes
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  2. F. Schwan
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  4. H. G. Gassner
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Corresponding author

Correspondence to H. G. Gassner.

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Conflict of interest

M. Rudes, F. Schwan, F. Klass, and H. G. Gassner declare that they have no competing interests.

The questionnaire was approved by the Institutional Review Board of the University of Regensburg. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Rudes, M., Schwan, F., Klass, F. et al. Turbinate reduction with complete preservation of mucosa and submucosa during rhinoplasty. HNO 66, 111–117 (2018). https://doi.org/10.1007/s00106-017-0450-9

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  • DOI: https://doi.org/10.1007/s00106-017-0450-9

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