Effects of turbinoplasty versus outfracture and bipolar cautery on the compensatory inferior turbinate hypertrophy in septoplasty patients

Abstract Introduction: The most common cause of septoplasty failure is inferior turbinate hypertrophy that is not treated properly. Several techniques have been described to date: total or partial turbinectomy, submucosal resection (surgical or with a microdebrider), with turbinate outfracture being some of those. Objective: In this study, we compared the pre- and postoperative lower turbinate volumes using computed tomography in patients who had undergone septoplasty and compensatory lower turbinate turbinoplasty with those treated with outfracture and bipolar cauterization. Methods: This retrospective study enrolled 66 patients (37 men, 29 women) who were admitted to our otorhinolaryngology clinic between 2010 and 2017 because of nasal obstruction and who were operated on for nasal septum deviation. The patients who underwent turbinoplasty due to compensatory lower turbinate hypertrophy were the turbinoplasty group; Outfracture and bipolar cauterization were separated as the out fracture group. Compensatory lower turbinate volumes of all patients participating in the study (mean age 34.0 ± 12.4 years, range 17-61 years) were assessed by preoperative and postoperative 2 month coronal and axial plane paranasal computed tomography. Results: The transverse and longitudinal dimensions of the postoperative turbinoplasty group were significantly lower than those of the out-fracture group (p = 0.004). In both groups the lower turbinate volumes were significantly decreased (p = 0.002, p < 0.001 in order). The postoperative volume of the turbinate on the deviated side of the patients was significantly increased: tubinoplasty group (p = 0.033). Conclusion: Both turbinoplasty and outfracture are effective volume-reduction techniques. However, the turbinoplasty method results in more reduction of the lower turbinate volume than outfracture and bipolar cauterization.

摘要 引言：鼻中隔成形术失败最常见的诱因为下鼻甲肥大未得到妥善处置。截至目前，临床已报道多种治疗术式：全鼻甲或部分鼻甲切除术、黏膜下鼻甲切除术（可采用外科手术方式或微切术器（microdebrider）操作），以及鼻甲外移术（turbinate outfracture）等。
目的：本研究借助计算机断层扫描（computed tomography，CT），对比两类手术患者的术前与术后下鼻甲体积：一类为接受鼻中隔成形术联合代偿性下鼻甲成形术（turbinoplasty）的患者，另一类为接受鼻甲外移术联合双极电凝（bipolar cauterization）的患者。
方法：本研究为回顾性研究，纳入2010年至2017年间因鼻塞就诊于我院耳鼻咽喉科、因鼻中隔偏曲接受手术的66例患者（男37例，女29例）。其中，因代偿性下鼻甲肥大接受下鼻甲成形术的患者归入成形术组；接受鼻甲外移术联合双极电凝的患者归入外移术组。本研究纳入患者的平均年龄为34.0±12.4岁，年龄范围为17~61岁；所有受试者均于术前及术后2个月接受鼻窦冠状位与轴位计算机断层扫描，以评估其代偿性下鼻甲体积。
结果：术后成形术组患者的下鼻甲横径与纵径均显著低于外移术组（p=0.004）。两组患者的下鼻甲体积均较术前显著降低（依次为p=0.002、p<0.001）。成形术组患者偏曲侧鼻腔的下鼻甲术后体积显著升高（p=0.033）。
结论：下鼻甲成形术与鼻甲外移术均为有效的鼻甲体积缩减术式。但相较于鼻甲外移术联合双极电凝，下鼻甲成形术可更显著地降低下鼻甲体积。