1. Turbinectomy
By Carly Winegar

2. Anatomy Nasal Turbinates (Nasal Concha) Supreme Superior Middle
Inferior
Eustachian tube has opening posterior to turbinates

3. Physiology
Forces air to flow steadily around the largest possible surface area of nasal mucosa to clean and warm the inhaled air to prepare it for the lungs
Ciliated mucous membrane with shallow blood supply
Bodies first line of defense against particles in inhaled air
Erectile tissue that causes nasal congestion or decongestion

4. Pathophysiology
Turbinate Hypertrophy- enlargement of the turbinates that obstructs the airways
Often caused by chronic rhinitis
Recurrent inflammations causes turbinate to lose elasticity

5. Diagnostic Exams Direct visual exam of the nasal passage
Mirror Examination
Sinuscopy
History and Physical to determine which method will be used

6. Surgical Intervention
Reducing the size or removal of the inferior hypertrophic turbinate (possibly other turbinates) to fix a nasal obstruction.

7. Special Considerations
May be performed in conjunction with other nasal procedures such as septoplasty, rhinoplasty, or sinus surgery.
Be familiar with the methods used by your facility and your surgeon’s preference:
Electrocautery
Sclerosing agents
Radiofrequency ablation
Cryosurgery
Argon Plasma surgery
Laser Turbinectomy

8. Anesthesia
General Anesthesia
Local Anesthesia

9. Positioning
Supine with head placed in donut or foam headrest or roll placed on scapular region to slightly tilt head back
Head of OR bed slightly elevated to reduce bleeding and prevent edema
Arms tucked at patient’s side
Ulnar nerves well padded and finger protected
Pillow placed under knees to reduce lumbar strain

10. Skin Prep
Prep begins at the upper lip and extends to hairlines and and beyond the chin
Removal of facial hair usually not necessary

11. Draping Turban-style to restrain the hair
Three wound towels may be placed in a triangular arrangement, then a bar sheet placed across the forehead with a split sheet or U-drape encircling the face and covering the body

12. Incision No incisions made to enter nasal cavity
Submucosal incision through lining of the nose

13. Supplies Medicine cups Local syringes Two 25 or 27-gauge needles
Long cotton tip applicators
Packing materials
Local anesthetic
Topical anesthetic (Cocaine 4%)
Protective eyewear for the patient

14. Equipment Headlamp ESU Bipolar unit
Insulated ESU with suction attachment
Laser (if doing laser method)
Carbon Dioxide
Nd:YAG
Diode lasers

15. Instruments Basic Nasal Set- ebonized if using laser Nasal Speculum
Bayonet forceps
Small scissors for trimming nasal hair if necessary
Periosteal elevator
Microdebrider
Microdebrider
Periosteal Elevator

16. Inferior Turbinectomy Steps
Submucosal approach is used
The nasal mucosa along the edge of affected turbinate is incised
A periosteal elevator is placed underneath the turbinate, elevating and fracturing it medially (referred to as infracturing)
Angled scissors and rongeur are used to excise the bone and soft tissue of the turbinate
Insulated electrocautery is used for hemostasis and suction followed by nasal packing

17. Microdebrider Turbinectomy
A small tube is inserted through a small submucosal incision within the nose
The microdebrider is inserted into the turbinate
A CT-guided imaging system is used to assist the surgeon in viewing the surgical site
The microdebrider is activated with the use of a foot pedal and it quickly and accurately removes the turbinate without damaging surrounding tissue

18. Laser Turbinectomy
A defocused laser beam or optical fiber delivery is used
Through the submucosal incision, the tissue is vaporized along the anterior inferior aspect of the turbinate to approximately one-half its length

19. Counts
Initial Count
When closing submucosa
Final Count

20. Dressing Materials Nose packed with gauze
Dry or impregnated with ointment (antibiotic or vaseline) to prevent crusting and infection and aid in removal
Patient provided with mustache-style dressing that may be secured with tape or tied around patient’s head
Patient forewarned before procedure that packing may be uncomfortable and will require breathing through mouth

21. Specimen Care
No specimen unless turbinate is removed- send to pathology

22. Prognosis Usually done on an outpatient basis
Responsible person drives patient home and stay with them for next 24 hours
A visit to the doctor’s office on the first or second postoperative day may be necessary to remove packing

23. Complications Hemorrhaging Postoperative dryness or crusting
Postoperative SSI
Formation of adhesions
Conchal bone necrosis

24. Wound Class/ Management
Class II: Clean- Contaminated