Aspiration-ultrasonic intracaneal turbinoplasty for nasal septum deviation complicated by inferior turbinate hypertrophy
A common cause of chronic nasal congestion is the pathology of the inferior turbinates. The act of nasal breathing is a complex process. The nature of the passage of air in the nasal cavity during breathing largely depends on the structure of the inferior turbinates. Nasal breathing, unlike mouth breathing, is physiological. Nasal obstruction in chronic nasal congestion leads primarily to mouth breathing.
The goal of sparing surgery for chronic nasal congestion should be to reduce complaints while maintaining function. Preservation of inspiratory resistance, resistor, and diffuser functions of the nose is guaranteed by minimally invasive technologies in the presence of hypertrophic rhinitis, it is necessary to correct the inferior turbinates.
There are a large number of different techniques for correcting the inferior turbinates in chronic nasal congestion. Currently, methods such as conchotomy, galvanocaustics, cryodestruction of the lower turbinates are considered unacceptable, since this results in a loss of a large area of the mucous membrane, the excretory, transport, and absorption function of the nose suffers, which leads to atrophic rhinitis. Therefore, for the correction of hypertrophied inferior turbinates in chronic nasal congestion, sparing methods are currently used, such as submucosal excision of the vessel, when the adducting vessels from the side of the bone are destroyed. If necessary, submucosal vasotomy is supplemented with lateroconchopexy - breaking of the bone base of the inferior turbinate and displacement of it to the side. Methods aimed at destroying the submucous cavernous plexuses of the inferior turbinates have become widespread. These include submucous diathermocoagulation, radio wave submucous coagulation, vasotomy, cavernosotomy, submucous cryodestruction.
The proposed methods of surgical treatment of chronic nasal congestion are minimally invasive, but to a greater or lesser extent they have a negative destructive effect on the mucous membrane.
The development of new, more gentle, functional surgical interventions for the treatment of chronic nasal congestion is a challenge today. Aspiration-ultrasonic intracaneal turbinoplasty does not injure the mucous membrane, reducing the volume of the turbinates. The most indicative is the dynamics of restoration of the respiratory function of the nose after surgery. 13 patients were operated on at the age of 9 to 15 years. The operation is performed under anesthesia developed by us with an aspiration-ultrasound device.
Submucosally, without injuring the mucous membrane of the inferior and middle turbinates, we perform intracancerous turbinoplasty, reducing the volume of the turbinates, restoring the lumen of the common nasal passage to normal, to eliminate obstacles in the path of the airflow leading to an impaired aerodynamics. Silicone tube inserts (splints) of the nasal septum - prevention of synechia. Anterior oil tamponade for a day. There were no complications during surgery and subsequent treatment. None of the patients developed synechiae, and nasal breathing was fully restored. The patients were discharged on average 2-3 days after the operation.
The new technologies of minimally invasive endonasal intracancerous turbinoplasty developed by us are the key to a stable positive clinical effect in chronic nasal congestion.
There is considerable disagreement on the merit of today's commonly performed destructive surgical techniques. In our opinion, the most gentle, functionally justified technology appears to be the method of choice in the treatment of chronic nasal congestion.