TURBINATE SURGERY
I believe in being very conservative with the turbinates. Many surgeons just snip or trim off a part of the turbinate. Then there are others that may carry this to the limit by which they remove most of the turbinate. I usually move the turbinate out toward the outside wall. This technique moves the turbinates toward the outside of the airway, purposefully causing scar tissue to the blood supply. This causes the turbinates to shrink, thereby improving the nasal breathing.
If the turbinates are very bulky (called hypertrophied), I perform what I call an endoscopic submucous resection of the turbinate. I do this by making a keyhole incision into the front part of the inferior turbinate and then with an instrument under endoscopic view, lift the soft tissue from the bone. I can then remove part of the turbinate bone, along with some of the soft tissue from the inside of the turbinate, while preserving the outside mucus membranes. Furthermore, I typically cauterize the remaining soft tissue of the interior of the inferior turbinate, and together this causes scarring of the vascular supply and the soft tissues, thereby causing the turbinate to shrink. While the turbinates shrink, I am able to preserve the entire mucus membrane.
I believe that preservation of the external membrane of the turbinate is paramount to getting a good result. Many surgeons cauterize, freeze,
and burn the outside membranes of the turbinates. These are accepted methods, but I believe these techniques cause considerable damage to the nose. I furthermore believe that over time less of this type of surgery will be performed and surgeons will be more conservative with the turbinates. However, today many surgeons would argue that removing some of the membranes is just as important to reduce postnasal drip. I disagree. Time will tell, but the pendulum seems to be swaying toward my philosophy.
I very rarely find reason to remove the middle turbinate, except when there is an air cell in the middle turbinate (concha bullosa) that is blocking the nasal airway. The only other time that I resect the middle turbinate is when there is considerable destruction by polyps, although even then, I try to be very conservative with my resection, hoping that I can leave enough of the turbinate so that when it heals it can provide the function of a near normal middle turbinate. Many surgeons resect part of the middle turbinate either with or without a concha bullosa. I believe that this is generally a mistake. Again, the overall philosophy is changing, urging surgeons to be as conservative as possible and try to preserve the middle turbinate.
