Comparison of radiofrequency applied to the total inferior choncha with application to its anterior third

Abstract

Objective

To compare radiofrequency application to the anterior 1/3 of the inferior choncha with application to the whole of the inferior choncha.

Material and method

40 patients with nasal obstruction due to isolated inferior choncha hypertrophy were evaluated. RF was applied in the first group only to the anterior 1/3 of the choncha, whereas in the second group the whole choncha was ablated. Anterior rhinomanometry measurements were obtained both before and 6 weeks after surgery along with visual analog scales. Complete data was used to compare the efficacy of both techniques.

Results

The combined nasal resistance showed a significant decrease in both groups. VAS scores were also substantial for both groups. Both groups showed similar data proving the two techniques to have similar efficacy.

Conclusion

Application to the anterior 1/3 compared with application to the whole of the choncha show no significant differences. Simple RF application here not only provides adequate control but also is safer as there is less risk of interruption of continuity of the nasal mucosa.

Introduction

The nasal valve area is the narrowest portion of the upper nasal airway and is solely responsible for 50% of total airway resistance. It is formed by the caudal margin of the upper lateral cartilage, anterior portion of the inferior choncha, the septum and base of the aperture pyriformis. Airflow speed is 2–3 m/s in the nostril and increases to 12–18 m/s at the nasal valve area. This results in the laminar airflow forming into a turbulent form, which in turn allows for more inhaled air to come into contact with nasal mucosa creating more warm and conditioned air [1], [2].

In practice nasal obstruction is observed to be caused by structural problems of components of this area. The inferior turbinate, as the predominant structure in this part of the nose, therefore plays a central role in conditioning of nasal air and in nasal obstruction [2], [3], [4].

In isolated inferior choncha hypertrophy the first approach should be medical with drugs including local and systemic steroids, oral and nasal decongestants and allergic desensitization [4]. Although medical treatments (i.e., local corticosteroids, antihistamines, decongestants) are frequently effective to restore comfortable nasal breathing, nasal obstruction is sometimes only slightly improved, leading some patients to increase their consumption of local decongestants with a high risk of iatrogenic effects [5]. Other than medical control a number of surgical interventions have been proposed. Several different techniques are currently available including total or partial turbinectomy, turbinoplasty, submucous resection, laser-assisted turbinoplasty, cryosurgery, treatment with infrared light, argon plasma surgery, topical application of AgNO₃, corticosteroid injections, and electrocautery with monopolar and bipolar technique [6], [7]. Unfortunately many of these techniques, especially the ones that are used on the total of the choncha may lead to serious complications like bleeding, scabbing, pain, hyposmia, synechia formation, bone necrosis and more mild complications including nasal mucosal damage which causes disruption of the mucociliary transport [7], [9].

This has lead to widespread use of radiofrequency thermal ablation which causes minimal disruption of mucociliary clearance [8], [9]. In this technique the total of the choncha is generally treated to decrease nasal airflow resistance. Our aim in this study was to state the efficacy of radiofrequency (RF) application to only the anterior 1/3 of the inferior choncha using objective and subjective measures.