Turbinectomy

Turbinectomy is a surgical procedure to trim or remove some or all of the turbinates from inside your nose. 

Turbinates (also called concha) are small, folded bony protrusions on the side-wall of the nasal cavity. They are covered by blood vessels, nerves, and mucous producing tissue. Each nasal cavity has three turbinates, namely inferior, middle, and superior. These turbinates filter, humidify, and add warmth to the air that enters the nostrils. Inferior turbinates make the primary contact with the air entering the nostril and trigger an immune response to foreign particles and pathogens. Unlike the inferior turbinate, other turbinates cannot trigger an immune response. During infections or allergies, turbinates become swollen and produce excess mucous, blocking the airflow inside the nasal cavity and causing congestion. In some cases, the inferior concha enlarges permanently and blocks the nose.

Turbinectomy is advised if medicines do not provide relief from the condition. The surgery is performed to trim or remove the swollen or enlarged turbinates, especially the inferior concha, to unblock the nasal cavity.

This surgery is recommended to provide relief from nasal obstruction caused due to any of the following conditions:

• Allergic rhinitis
• Inferior turbinate hypertrophy (enlargement of the inferior turbinates): Symptoms of the condition include:
  • Nosebleeds
  • Snoring
  • Difficulty breathing
  • Difficulty sleeping
• Nasal septal deviation 
• Chronic non-allergic rhinitis: Symptoms of the condition include:
  • Sneezing
  • Runny nose
  • Reduced sense of smell
  • Mild irritation in and around the nose

The surgery will not be performed in individuals with bleeding disorders.

You will need to visit the surgeon a few days prior to the surgery for a preoperative assessment wherein your doctor will conduct a physical examination and ask you about the following:

• Current and past medical conditions
• History of anaesthesia or allergy to it
• Any other allergies
• Whether you are pregnant
• A list of medicines that you take, including vitamins, herbs, and over-the-counter medications

Additionally, the doctor will order the following tests:

• Blood tests
• Urine tests
• Pregnancy test
• Allergy skin test

He/she will also provide you with the following instructions:

• Discontinue blood thinners like aspirin, warfarin, and ibuprofen prior to the surgery.
• Quit smoking if you do. 
• Inform the surgeon if you have a cold, flu, or fever on the days leading to the surgery. In such a case, your surgery may be postponed.
• Fast from midnight of the night prior to the surgery. Fasting is recommended before the surgery to prevent vomiting (risk of general anaesthesia) during the surgery.
• Shower and remove all make-up, nail polish, and body piercings before you arrive at the hospital on the scheduled day of the surgery.
• Arrange for a friend, family member, or responsible adult to drive you home following the procedure.
• Sign an approval form if you agree to the procedure.

After you arrive at the hospital, the hospital staff will ask you to wear a hospital gown. They will start an intravenous (IV) line in your arm to provide you with essential fluids and medicines during the surgery. The surgery will be done either with general or local anaesthesia. General anaesthesia will make you fall in a deep sleep while local anaesthesia will numb the area of operation during the surgery.

Once you are under the influence of anaesthesia, the surgeon will remove or trim the turbinates by one of the following methods:

• Diathermy: A needle is placed on the turbinate and electric current passed through it.
• Microdebrider-assisted turbinectomy: Microdebrider is a high-speed instrument that is inserted into the nasal cavity to remove the turbinates.
• Cryoturbinectomy: In this method, the turbinate is subjected to argon gas or liquid nitrogen using a needle-like applicator to freeze and destroy the tissue.
• Radiofrequency turbinate reduction or laser ablation: This method uses radiofrequency energy, passed through a needle-like instrument, to damage and reduce the turbinate in a controlled manner.
• Laser turbinectomy: This procedure is similar to radiofrequency reduction; however, it uses laser light instead of radiofrequency energy to reduce the turbinates.

The surgeon may use the assistance of an endoscope to perform the surgery, which is a thin, long tube with a camera and light source at one end. The endoscope will display the images of the insides of your nasal cavity on a television screen during the surgery.

After the turbinates are trimmed or removed, the surgeon will pack your nose on the inside with dissolvable or non-dissolvable packing to prevent bleeding.

The surgery lasts for 15 to 30 minutes. If the surgery is conducted under general anaesthesia, you will feel tired, restless, and groggy and experience dry mouth and sore throat after you regain consciousness. These are the side effects of general anaesthesia that usually fade within a few hours.

The type of packing used inside the nose may determine the duration of your hospital stay. Although individuals undergoing surgery are usually discharged on the same day, you will need an overnight stay at the hospital if non-dissolvable packing is used. These packings are removed on the day after the surgery.

You will experience a blocked nose, increased mucus production, and notice dried blood in your nose during the initial few weeks following the surgery. The surgeon will provide the following instructions to take care of yourself after discharge from the hospital:

• Keep yourself well hydrated.
• Take pain-relief medicine and use lubrication and nasal spray as prescribed by the surgeon.
• Avoid strenuous activities or exercises for at least two weeks after the surgery. Even after that, consult with the surgeon before you resume exercising.
• Avoid taking alcohol during the initial one week after the surgery as it increases the risk of bleeding.
• Avoid crowded places and smoky or dusty environments for a week after the surgery.
• The surgeon may ask you to regularly rinse the operated nasal cavity with a salt solution.
• Do not pick your nose and avoid forceful blowing of your nose during the healing period.
• You should rest at home for at least two weeks to avoid catching the flu or infection.
• Avoid smoking as it can affect healing.
• You will be allowed to resume sexual activity soon after the surgery.

It may take around six weeks for the operated area to heal completely after the surgery. After the recovery period, you will likely experience relief from nasal obstruction. 

When to see the doctor?

Contact the surgeon if you experience the following symptoms:

• High body temperature
• Diarrhoea
• Difficulty breathing 
• Sunburn-like rash throughout the body
• Confusion
• Redness on the tongue, lips, and whites of the eyes
• Symptoms of flu such as a headache, cough, fatigue, sore throat, and body pain

The potential complication/risks associated with the surgery include:

• Toxic shock syndrome
• Atrophic rhinitis (a debilitating disease of the nasal cavities)
• Crusting in the nose
• Scar tissue
• Damage to the tear duct of the eye
• Increased discharge from the nasal cavity
• Bleeding
• Pain
• Reaction to anaesthesia
• Infection of the operated site
• Blood clots in lungs or legs

The follow-up schedule will be provided to you before discharging you from the hospital. 

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.