Turbinate Augmentation and Nasal Airway Constriction With Filler Injection
Video description: If the inferior turbinates in the nose are surgically removed or minimized in excess, due to the abnormal acceleration of the air taken from the nose, such as humidification, refinement and pressurizing nose tasks can not be done.
In this case, called Empty Nose Syndrome (ENS), there is a limited amount of treatment option. Although this video does not have a permanent effect, it is shown that the volume of lower turbinates is increased by injecting hyaluronic acid-containing dermal fillings under local anesthesia.
What is Empty Nose Syndrome?
Deterioration in nasal functions, dryness in the nose and a feeling of sticky intranasal secretion in the genitalia, which occurs as a result of the abnormal reduction or surgical removal of the structures called turbinate in the nose, which provides the rotation of the air flow, humidification, purification and pressurization of the air in the nose by narrowing the air space in the nose. It is a condition in which symptoms such as the appearance of painful areas in the nose and the feeling of air hunger are seen.
In Which Situation Does Empty Nose Syndrome Occur?
Empty nose syndrome may occur in case of abnormal enlargement of the air passage in the nose, decrease in airway resistance and acceleration of the incoming airflow (nasal hyperventilation). In particular, the inferior turbinates are the main organs responsible for airway resistance in the nose. As a result of simple resection of these structures with scissors, their anomalous reduction by applying excessive radiofrequency, or their anomalous reduction with devices such as shavers, nasal functions are adversely affected due to linear accelerated air inflow due to the enlarged air passage. The fact that the inside of the nose is very wide and the intake of air is high does not always mean that more oxygen will be taken.
What Are the Symptoms in Patients With Empty Nose Syndrome?
In patients with empty nose syndrome, the following complaints that can be felt by the patients may occur during the movement of cold, dirty, unpressurized and dry air entering the nose to the nasal and lower respiratory tracts:
- dry nose
- sticky and non-easily removable secretions in the nasal passages
- the presence of painful areas in the nose over time
- feeling of insufficient air intake (can be confused with nasal congestion)
- feeling of cold and dry air in the nose
- reduced tolerance to dry, cold and hot environments
- in some patients the occurrence of chronic rhinosinusitis or atrophic rhinitis may be facilitated
Nose Without Turbinate - It's Like A Simple Pipe Without Function!
Thanks to the turbinate structures in our nose, our nose fulfills unique tasks. Thanks to the structures called turbinates, which are 3 in each nasal cavity, the air entering the nose is rotated, slowed down, heated, humidified, pressurized, and in this way goes to the lower respiratory tract - the lungs. So the presence of turbinates is very important, which ensures that it is not a simple tubular structure. They are warm structures due to the dense blood vessel network inside the turbinates. There are ciliated epithelium and mucus layer on the outer parts. The air hitting these structures, which are in the form of spouses, covered with a layer of mucus on the outside, has to slow down by making a rotational movement, and proceeds backwards by being heated and purified. Particles, microorganisms, allergens in the air adhere to the mucus layer on the outside of the turbinates. Thanks to the cilia, the mucus is regularly pushed to the back of the nasal cavity, we swallow this dirty mucus secretion without realizing it, and all the microorganisms and particles in the mucus in our stomach are eliminated.
How should healthy turbinates be?
In order for the turbinates in the nose to perform their duties, they must have the following features:
- adequate capillary circulation network and warm (intense fibrosis, reduced circulation can occur due to excessive radiofrequency or laser application, when the turbinates become "cold", their job of heating the air is adversely affected)
- sufficient size (due to excessive reduction or surgical resection of the turbinates, the air entering the nose can pass through the nose very quickly and linearly. In this way, not enough time passes for the turbinate + nasal air contact, dirty, cold entering the nose and dry air may travel backwards, into the lower airways)
- healthy and moist surface mucosa (there is a moist, mucus-covered, ciliated respiratory epithelium outside the turbinates, changes in this epithelium due to cautery, radiofrequency or laser applications that cause heat damage during turbinate reduction may cause adverse effects on turbinate functions. ).
How Long Does Turbinate Filler Injection Last?
Fillers containing hyaluronic acid, which are normally used in liquid rhinoplasty or lip filler injections, are completely absorbed in the body (some of them turn into collagen) within 10-12 months and disappear. In patients with very reduced turbinate volume, no long-term effect can be achieved with gel filler injection alone. In these patients, a few months after the injection, when the melting of the filler begins, it is the complaint of drying in the nose or the movement of cold air towards the nasal cavity (nasal hyperventilation), which is immediately expressed by the patients. In patients whose turbinate volume has not been reduced too much and the anterior part of the inferior turbinate is large enough (because the air entering the nose is compressed and slowed down), the effect can be felt longer with the filler injection. In patients with a very small turbinate volume and an already abnormally enlarged intranasal air passage, gel filler injection may not provide sufficient effect anyway. Therefore, assessing a duration of action in these patients is not easy.
How Many Months Should Turbinate Filler Injection Be Made?
Here, the decision is made according to patient satisfaction. As I wrote above, while an injection every 6-8 months may be sufficient in patients with sufficient turbinate volume; In patients with very small turbinates, more frequent repetitions may be required. Turbinate filler injection may not be an ideal treatment tool in noses with a very large intranasal air passage and whose anatomy has been changed excessively by turbinate resection.
Filler Injection to The Turbinate Price
The cost of gel filler injection to the turbinate in Istanbul is 350-500 us dollars when the elephant box containing 1 sterile injector is opened, and 600-900 us dollars when two elephants cans are opened.
Turbinate Filler Injection Processing Time
It is a practical and simple application that can be done within 5-10 minutes, usually in office conditions.
Possible Side Effects of Turbinate Filler Injection
In general, allergic reactions, nodule formation, infection, bleeding at the injection site can be seen, which are the side effects of fillers containing hyaluronic acid. So far, I have not encountered any other side effects, except for temporary bleeding. The use of CE certified products can reduce the possibility of application technique side effects.
Postprocedure Patient Care For Turbinate Filler Injection
Although there is no special care recommendation after Turbinate a gel filler injection; It is ideal to avoid exercise activities that can increase blood pressure in the head area for a few days, not to consume spicy and foods, and not to use blood thinners for a few days.
Is Turbinate Filler Injection Easy?
Although Turbinate gel filler injection is normally an easy and simple procedure; In patients whose turbinate tissue is fibrotic and stiff due to previous radiofrequency ablation, there may be difficulty during injection. You can think of it as gel injection into the scar tissue. For this reason, it is necessary not to use very thin needles and to be careful in terms of possible breakage of the injector.
Can Turbinate Filler Injection be Used to Determine The Areas That Need to be Narrowed in The Nose Before Durgery?
In patients with nasal hyperventilation and who are planned to narrow certain areas in the nose with implantation or flap techniques, filler injection can be tried primarily in terms of being a candidate for surgery. Intranasal airway narrowing, which can be obtained with filler injection, is generally less than that of implantation, and this issue can be discussed between the physician and the patient in patients whose complaints are reduced only by filler injection.
Does Nose Shape Change After Turbinate Filler Injection?
During the growth of turbinates with gel filler injection, the air passage in the nose narrows, while there is no change in the shape of the nose. Depending on the cotton placed in the nose after the procedure, sometimes the nostrils may appear slightly enlarged. However, when the cottons are removed, the nose returns to its original shape.
Is Nasal Packing or Nasal Bandage Necessary After Turbinate Filler Injection?
After the gel filler injection to the turbinate procedure, it is sufficient to simply insert cotton into the nose and remove the cotton after 30-60 minutes. There is no need to apply any bandage or splint to the outside of the nose. There is no aesthetic change from the outside.
Link group where you can reach other articles about Empty Nose Syndrome on this website >> https://www.ent-istanbul.com/search?q=empty+nose+syndrome
Source links >> Empty nose syndrome - PubMed / Surgical Treatment for Empty Nose Syndrome - JAMA Network / Empty nose syndrome - ScienceDirect
Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul
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