Turbinectomy is an endonasal surgery to remove part of the inferior turbinates. These small growths located in the nasal cavities can indeed, when they are too large, lead to nasal obstruction and repeated infections.

Turbinectomy is a surgical procedure that involves the partial removal of the inferior turbinates to improve nasal ventilation.

As a reminder, each nasal cavity has three turbinates: the upper turbinate, the middle turbinate and the lower turbinate. These are bone formations, called turbinal bone, rolled up on themselves and covered with an erectile mucosa that will alternately expand and then contract on each side every 3 to 5 hours. This cycle of vasodilation / vasoconstriction allows you to warm and humidify the breathed air.

The turbinectomy will consist in cutting part of the bone and the mucous membrane of the inferior turbinate in order to reduce its volume.

Turbinectomy is usually performed under general anesthesia for more comfort. It is performed under endoscopic control, from the inside of the nose and therefore does not require any scarring. The gesture lasts about twenty minutes.

The surgeon will cut approximately 2/3 of the inferior turbinates, bone and mucosa included. 

A gesture on the nasal septum (septoplasty) is sometimes necessary during the same operation in the event of deviation of the nasal septum increasing the nasal obstruction.

A wicking is sometimes put in place to limit postoperative bleeding.

In certain inflammatory diseases of the nose and sinuses, such as an allergy, chronic sinusitis, polyposis (presence of multiple polyps), the mucous membrane of the turbinates constantly enlarges.

Turbinectomy can be proposed after failure of medical and local treatments (nasal spray, cortisone, serum, etc.), when the lower turbinates cause nasal obstruction, resulting in respiratory discomfort, the impression of having the nose blocked all the time. , and sometimes repeated infections. Removing part of the bone and the mucous membrane will then free up space in the nasal cavities and thus improve nasal ventilation.

Note that there are other techniques to reduce the volume of the inferior turbinates:

• electric cauterization is the simplest technique. It involves partially cauterizing the horns below the bipolar forceps. This procedure is performed in an ENT office, under local anesthesia;
• radiofrequency or laser turbinosplasty allows a deeper partial destruction of the turbinates. It is practiced in the clinic, under local anesthesia or a short general anesthesia;
• Surgical turbinoplasty is the surgical removal of part of the turbinate bone, without touching the mucosa. This makes it possible to reduce the volume of the turbinate while preserving the physiological properties of the mucosa.

Operative suites

They are not very painful. By the time the wounds heal, i.e. 3 to 4 weeks, scabs will persist and sometimes give the impression of a dry nose. Daily local care is essential to promote healing and limit the risk of infection.

If a wicking has been put in place, antibiotic treatment will be prescribed. The wicks will be removed after 24 to 48 hours depending on the establishment. Sometimes a little bleeding occurs; it will usually stop spontaneously.

Tearing due to irritation of the tear ducts may persist for some time.

The results

The intervention improves nasal ventilation. However, it has no effect on runny nose and sneezing. However, nasal obstruction may remain due to deformity of the nasal septum or scarring endonasal adhesion.

Complications

Beyond the risks associated with general anesthesia, turbinectomy can cause rare complications:

• secondary bleeding which will require urgent surgical hemostasis.
• empty nose syndrome (SNV): this rare phenomenon can occur following excessive excision of the turbinates which will lead to a change in nasal physiology. The patient then has the impression of breathing badly while his nasal passages are wide enough to let air pass. To prevent this very disabling complication on a daily basis, it is essential to correctly state the indication for surgery and during the operation, to measure the resection of the turbinates. Total turbinectomy (removing the entire inferior turbinate) is also rarely performed.