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International Journal of Environmental... Mar 2021Surgical treatment of the inferior turbinates is required for hypertrophic inferior turbinates refractory to medical treatments. The main goal of surgical reduction of... (Review)
Review
Surgical treatment of the inferior turbinates is required for hypertrophic inferior turbinates refractory to medical treatments. The main goal of surgical reduction of the inferior turbinate is to relieve the obstruction while preserving the function of the turbinate. There have been a variety of surgical techniques described and performed over the years. Irrespective of the techniques and technologies employed, the surgical techniques are classified into two types, the mucosal-sparing and non-mucosal-sparing, based on the preservation of the medial mucosa of the inferior turbinates. Although effective in relieving nasal block, the non-mucosal-sparing techniques have been associated with postoperative complications such as excessive bleeding, crusting, pain, and prolonged recovery period. These complications are avoided in the mucosal-sparing approach, rendering it the preferred option. Although widely performed, there is significant confusion and detachment between current practices and their basic objectives. This conflict may be explained by misperception over the myriad of available surgical techniques and misconception of the rationale in performing the turbinate reduction. A comprehensive review of each surgical intervention is crucial to better define each procedure and improve understanding of the principle and mechanism involved.
Topics: Catheter Ablation; Humans; Hypertrophy; Nasal Obstruction; Treatment Outcome; Turbinates
PubMed: 33810309
DOI: 10.3390/ijerph18073441 -
Cureus Oct 2021Inferior concha bullosa is a rare disease that has been related to sinonasal symptoms. This study aimed to determine the characteristics of concha bullosa in the... (Review)
Review
Inferior concha bullosa is a rare disease that has been related to sinonasal symptoms. This study aimed to determine the characteristics of concha bullosa in the inferior turbinate and assess its common clinical manifestations, computed tomography findings, and the surgical techniques used to treat the condition. We conducted a search of the PubMed database, using the Preferred Reporting Items of Systematic Reviews and Meta-Analysis, for articles published until May 2021 using the following terms: "inferior turbinate and concha bullosa"; "inferior turbinate and pneumatization"; and in combination with other terms such as "concha bullosa release and concha bullosa excision", among others. We found 12 papers that met our inclusion criteria. The main presenting symptom was a nasal obstruction in 13 patients (100%), followed by headache in 10 patients (77%). The site of inferior concha bullosa was bilateral in six cases and left-sided in five cases. Computed tomography was conducted in all cases in this review. The type of intervention performed was medical, surgical, and both in 23%, 54%, and 23% of the cases. Despite multimodal surgical approaches and medical treatment, all the outcomes were good and no compactions were noted. All cases also had good prognoses.
PubMed: 34868747
DOI: 10.7759/cureus.19089 -
Indian Journal of Otolaryngology and... Dec 2018Techniques for inferior turbinate reduction vary with various surgical methods, which differ in the approach of preservation of tissue from total turbinectomy to limited...
Techniques for inferior turbinate reduction vary with various surgical methods, which differ in the approach of preservation of tissue from total turbinectomy to limited submucosal cauterization. Our preferred method to address hypertrophic inferior turbinate by mini turbinoplasty-tunneling technique are presented. Critical steps include creation of window in the inferior turbinate with a 4 mm microdebrider blade and removal of both inferior turbinate mucosal hypertrophy and bony component to convert a convex looking inferior turbinate to concave shape. This allows proper debulking of the entire medial aspect of the inferior turbinate and widening of the nasal valve area. Mini turbinoplasty-tunneling technique for hypertrophic inferior turbinates, is a safe method in achieving turbinate size reduction with minimal morbidity and long-term relief of nasal obstructive symptoms without added risk of complications.
PubMed: 30464924
DOI: 10.1007/s12070-018-1292-9 -
European Annals of Otorhinolaryngology,... Dec 2018The surgical technique of olfactory cleft dilatation consists in transmucosal lateral fracture-dislocation of the lateral wall of each olfactory cleft (i.e., of the...
The surgical technique of olfactory cleft dilatation consists in transmucosal lateral fracture-dislocation of the lateral wall of each olfactory cleft (i.e., of the turbinate wall of the ethmoid, composed, from anterior to posterior, of the middle, superior and supreme turbinates), in order to get access to the recess hosting the human olfactory mucosa and to the roof of the olfactory cleft (i.e., cribriform plate), with minimal trauma to the mucosa. Olfactory cleft dilatation is indicated for dysosmia secondary to constitutional stenosis of the olfactory clefts due to abnormal development of the ethmoid. Constitutional stenosis of the olfactory clefts should be differentiated from inflammatory obstruction and other diseases of the olfactory clefts, and especially from respiratory epithelial adenomatoid hamartoma, which enlarges the olfactory clefts and must be treated by resection. The technique of olfactory cleft dilatation is illustrated by three surgical cases. There was clear improvement in dysosmia in all three cases, without any complications. The place of constitutional olfactory cleft stenosis needs still to be defined in both diagnosis and treatment of dysosmia.
Topics: Adolescent; Adult; Constriction, Pathologic; Dilatation, Pathologic; Endoscopy; Ethmoid Bone; Female; Glucocorticoids; Humans; Nasal Obstruction; Nasal Septum; Olfaction Disorders; Tomography, X-Ray Computed; Turbinates; Young Adult
PubMed: 29934261
DOI: 10.1016/j.anorl.2018.05.008 -
European Annals of Otorhinolaryngology,... Jun 2015Angiosarcoma is a malignant tumour arising from endothelial cells that accounts for 1% of all sarcomas. The sinonasal site of angiosarcoma is exceptional.
INTRODUCTION
Angiosarcoma is a malignant tumour arising from endothelial cells that accounts for 1% of all sarcomas. The sinonasal site of angiosarcoma is exceptional.
CASE REPORT
The authors report a case of sinonasal angiosarcoma in a 53-year-old man. Despite wide resection by open surgery and postoperative chemoradiotherapy, several tumour recurrences were observed, requiring multiple operations.
DISCUSSION
Only histological examination with immunohistochemistry is able to confirm the diagnosis (factor VIII, CD34 and CD31 antigens). Standard treatment consists of surgery with wide resection followed by radiotherapy. The authors discuss the treatment modalities and prognosis of this tumour.
Topics: Chemoradiotherapy; Diabetes Mellitus, Type 2; Ethmoid Sinus; Fatal Outcome; Hemangiosarcoma; Humans; Hypertension; Male; Middle Aged; Natural Orifice Endoscopic Surgery; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Neoplasm Staging; Paranasal Sinus Neoplasms; Risk Factors; Turbinates
PubMed: 25698587
DOI: 10.1016/j.anorl.2015.01.006 -
Acta Otorhinolaryngologica Italica :... Oct 2022
Review
Topics: Humans; Treatment Outcome; Nasal Mucosa; Turbinates; Hypertrophy; Nasal Obstruction
PubMed: 36541379
DOI: 10.14639/0392-100X-N1896 -
Acta Bio-medica : Atenei Parmensis Aug 2022Allergic rhinitis (AR) and non-allergic rhinitis (NAR) belong to field of vasomotor rhinitis, characterized by nasal hyper-reactivity. Since AR and NAR are two separate...
BACKGROUND AND AIM
Allergic rhinitis (AR) and non-allergic rhinitis (NAR) belong to field of vasomotor rhinitis, characterized by nasal hyper-reactivity. Since AR and NAR are two separate nosological entities, these rhinopaties can coexist in the same patient in up to 15-20% of cases. Overlapped rhinitis (ORs) are associated with intense and persistent symptoms and are often misdiagnosed. Typically, when medical treatment fails, patients undergo turbinate surgery. We evaluated which rhinopaties are most at risk of undergoing turbinate surgery and established the percentage of ORs. Methods: The study included 120 patients undergoing turbinate surgery for turbinate hypertrophy. Anterior rhinoscopy, nasal endoscopy, nasal cytology, skin prick tests (SPT) and/or specific IgE serum assays (CAP-RAST) were performed preoperative on all patients.
RESULTS
Among patients with indication for turbinate surgery, 75% suffered from AR, whereas 25% of them had NAR. On closer analysis, only 7 (8%) of allergic patients presented a "pure" allergy. NAR with eosinophils and mast cells (NARESMA) represented the most common type of superimposed rhinitis (62.5%), while NAR with mast cells (NARMA) and with eosinophils (NARES) represented 25% and 12.5% of the superimposed forms, respectively.
CONCLUSION
Most of the patients undergoing turbinate surgery actually have complex forms of rhinitis. The non-allergic component of ORs often causes therapeutic failure. NARESMAs overlapping ARs are at most risk of undergoing turbinate surgery. Correctly framing a rhino-allergological patient is essential in order to guarantee the most adequate treatment. Hence the importance of introducing in clinical practice investigations, including allergy tests and nasal cytology.
Topics: Eosinophils; Humans; Rhinitis; Rhinitis, Allergic; Skin Tests; Turbinates
PubMed: 36043980
DOI: 10.23750/abm.v93i4.12200 -
Current Opinion in Allergy and Clinical... Feb 2020Immune system modulators have been under investigation to help elucidate the underlying pathophysiologies of chronic rhinosinusitis (CRS). Psoriasin (S100A7) and... (Review)
Review
PURPOSE OF REVIEW
Immune system modulators have been under investigation to help elucidate the underlying pathophysiologies of chronic rhinosinusitis (CRS). Psoriasin (S100A7) and calgranulins (S100A8, S100A9, and S100A12) are S100 proteins that have been studied for their immune-mediating responses to pathogens within the context of CRS. This review highlights the expression patterns and proposed roles of S100 proteins in CRS with (CRSwNP) and without (CRSsNP) nasal polyps.
RECENT FINDINGS
Elevated levels of S100A7 and S100A12 were measured in the sinonasal tissues of patients with CRSsNP compared with CRSwNP and controls. S100A12 expression in CRSsNP was significantly correlated to disease severity. Contrastingly, increased S100A8, S100A9, and S100A8/A9 levels were demonstrated in the nasal polyp tissues of patients with CRSwNP compared with those in inferior turbinate and uncinate tissues of patients with CRSsNP and controls.
SUMMARY
The reported differential expression patterns and activities of psoriasin and calgranulins suggest that S100 proteins exert unique and concerted roles in mediating immunity in different subtypes of CRS. These studies will enable further investigations focused on understanding the immune-modulating mechanisms of S100 proteins in different inflammatory signaling pathways and disease phenotypes of CRS toward the pursuit of identifying new biomarkers and targets for improved outcomes.
Topics: Biomarkers; Chronic Disease; Disease Progression; Gene Expression Regulation; Humans; Inflammation; Nasal Polyps; Rhinitis; S100 Proteins; Signal Transduction; Sinusitis; Turbinates
PubMed: 31644435
DOI: 10.1097/ACI.0000000000000595 -
JAMA Otolaryngology-- Head & Neck... Aug 2022To the authors' knowledge, no prior studies have examined the association between inferior turbinate hypertrophy (ITH) and extraesophageal reflux (EER). If EER were a...
IMPORTANCE
To the authors' knowledge, no prior studies have examined the association between inferior turbinate hypertrophy (ITH) and extraesophageal reflux (EER). If EER were a cause or cofactor of ITH, antireflux treatment can be considered prior to surgical intervention.
OBJECTIVE
To evaluate EER presence and severity in patients with different degrees of ITH.
DESIGN, SETTING, AND PARTICIPANTS
Prospective multicentric cohort study conducted at 3 referral centers treating patients with EER and certified for 24-hour monitoring of oropharyngeal pH. The monitoring was performed between October 2020 and October 2021. A total of 94 adult patients with EER symptoms were recruited, 90 of whom were analyzed.
INTERVENTIONS
Nasal endoscopy was performed to determine the degree of ITH, according to the Camacho classification. Presence and severity of EER were examined using 24-hour monitoring of oropharyngeal pH.
MAIN OUTCOMES AND MEASURES
Primary outcomes were presence of EER according to RYAN Score, total percentage of time below pH 5.5, and total numbers of EER events below pH 5.5.
RESULTS
Of the 90 analyzed patients (median [IQR] age, 46 [33-58] years; 36 [40%] male patients), 41 had a maximum of second-degree ITH (group 1), and 49 patients had at least third-degree ITH (group 2), according to the Camacho classification. On the basis of the RYAN Score, EER was diagnosed more often in group 2 (69.4%) than in group 1 (34.1%; difference, 35.3% [95% CI, 13.5%-56.9%]). Moreover, compared with group 1, group 2 exhibited higher median total percentage of time below pH 5.5 (median [IQR], group 1: 2.1% [0.0%-9.4%], group 2: 11.2% [1.5%-15.8%]; difference, 9.1% [95% CI, 4.1%-11.8%]) and higher median total number of EER events (median [IQR], group 1: 6 [1-14] events, group 2: 14 [4-26] events; difference, 8 [95% CI, 2-15] events). Patients with proven EER demonstrated no difference in the degree of ITH between the right and left nasal cavity (Cohen g, -0.17 [95% CI, -0.50 to 0.30]), or between the anterior and posterior parts of the nasal cavity (Cohen g, -0.21 [95% CI, -0.50 to 0.17]).
CONCLUSIONS AND RELEVANCE
In this cohort study, patients with a higher degree of ITH had more severe EER. A possible association between severe ITH and EER was demonstrated.
Topics: Adult; Cohort Studies; Female; Gastroesophageal Reflux; Humans; Hypertrophy; Male; Middle Aged; Paranasal Sinus Diseases; Prospective Studies; Turbinates
PubMed: 35771544
DOI: 10.1001/jamaoto.2022.1638 -
Archives of Craniofacial Surgery Jun 2017Turbinate hypertrophy is one of the common causes of chronic nasal obstruction. In principle, therapeutic guidelines recommend medical treatment. Failure to treat...
BACKGROUND
Turbinate hypertrophy is one of the common causes of chronic nasal obstruction. In principle, therapeutic guidelines recommend medical treatment. Failure to treat turbinate thickening despite drug therapy may indicate the need for surgery. The main aim of this study was to determine the effect of radiofrequency surgery, among various other surgical procedures, on people with both nasal septal deviation and turbinate hypertrophy.
METHODS
Among people with nasal deviation who visited the subject hospital between July 2008 to July 2014, 21 people with nasal septal deviation and severe turbinate hypertrophy before their surgery had undergone septoplasty with turbinoplasty using radiofrequency combined with septoplasty. The degree of the turbinate's hypertrophy was appraised in all the patients before and after the surgery using the rhinoscopy, and acoustic rhinometry was objectively carried out. The subjective effect of the turbinoplasty using radiofrequency was explored through the visual analog scale (VAS) score.
RESULTS
The degree of contraction of the nasal mucosa after the rhinoscopy changed from Grades 3 and 4 (100%) to Grades 1 and 2 (95.2%) and Grades 3 (4.8%). The minimal cross-sectional area significantly increased from 0.44±0.07 to 0.70±0.07 cm (<0.05). The nasal cavity volume increased from 4.79±0.49 to 6.76±0.55 cm (<0.05). The subjective symptoms evaluated with VAS score a year after the surgery significantly improved (<0.05).
CONCLUSION
Turbinoplasty using Coblator with septoplasty is an effective treatment method because it expands nasal cavity, has a low incidence of complications, subjectively improves symptoms, and has short treatment duration.
PubMed: 28913312
DOI: 10.7181/acfs.2017.18.2.82