Comparison of Inferior Turbinate Reduction Techniques on Postoperative Epistaxis and Nasal Congestion

Abstract

Inferior turbinate hypertrophy is commonly found in patients with nasal obstruction and is often concurrent with septal deviation. Medical therapy for inferior turbinate hypertrophy includes an antihistamine or nasal decongestant spray [1]. If hypertrophied inferior turbinates are refractory to medical management, surgical reduction of the turbinates can be performed [2,3]. Several techniques exist for surgical inferior turbinate reduction. Submucous resection of the inferior turbinates involves removing the underlying bone and erectile tissue of the turbinates while sparing the mucosal tissue [4,5]. In contrast, partial excision of the inferior turbinates involves trimming portions of the inferior turbinate bone along with its overlying mucosa [4]. Both techniques are often performed in conjunction with outfracturing of the inferior turbinates, which lateralizes the entire turbinate structure and expands the internal nasal valve. Other surgical methods for inferior turbinate reduction include total turbinectomy, microdebrider removal, electrocautery, laser cautery, cryotherapy, and radiofrequency ablation [1,3-4,6-9]. Turbinate reduction surgery can be associated with adverse postoperative outcomes such as postoperative epistaxis, nasal congestion, infection, and nerve injury, and empty nose syndrome [4,10]. There is literature which comments on the rate of postoperative complications and the type of surgical technique utilized. For example, previous studies described rates of epistaxis to be 1.6% after submucous resection with a microdebrider and 5.8% after radical turbinectomy [9,11]. Other studies comment on nasal congestion: 96% of patients reported an improvement in nasal breathing two weeks after surgery, and 88% after two months, after undergoing bilateral inferior turbinate reduction. This was compared to 78% of patients who reported improvement after two weeks, and 76% after two months, after a submucosal diathermy turbinate reduction [12]. The purpose of this study was to compare two surgical techniques of inferior turbinate reduction, submucous resection versus partial excision, with their associated postoperative complications including epistaxis and recurrent nasal congestion in patients undergoing functional nasal surgery at a single academic center. To date, no other study has directly compared these two methods with endpoints of epistaxis and nasal congestion.