Turbinate Volume Reducing Procedures May Effect The Autonomic Reflex

Inferior Turbinate Outfracture May Cause an Increase in Heart Rate, Systolic and Diastolic Blood Pressures During The Operation!

Vasomotor Rhinitis, Autonomic Nervous System, Turbinate Outfracture, Heart Rate, Blood Pressure
Turbinates and nasal mucosa, which are responsible for slowing, warming, humidifying and filtering the inhaled air taken from the nose, work under the control of the autonomic nervous system.

The autonomic nervous system can change the blood flow and mucus secretion to the nasal mucosa by controlling the change in the diameter of the capillary vessels passing through the nasal mucosa. When sympathetic nervous system activity decreases and parasympathetic nervous system activity increases, capillary vessel diameters increase, edema in the nasal mucosa increases, nasal secretion increases and nasal congestion may occur. Further activation of the parasympathetic nervous system may also increase mucosal secretions leading to excessive rhinorrhea (as in Vasomotor Rhinitis).

In a scientific study published by my dear doctor friend Dr.Bulut et al., they emphasized that there was a significant increase in intraoperative heart rate, systolic and diastolic blood pressures during the operation, while outfracture was performed in order to reduce the turbinate volume in patients with turbinate hypertrophy and associated nasal obstruction. . Link of the article they published in the "European Archives of Oto-Rhino-Laryngology" >> Autonomic reflex effect of the inferior turbinate outfracture or bipolar cauterization inferior turbinate reduction surgery

In the treatment of turbinate hypertrophy, except for medical treatment, procedures that cause the least mucosal damage and change the anatomy the least are recommended. Turbinate outfracture is the process of expanding the nasal passage by inserting a metal instrument into the nose and pressing it laterally, crushing the bone in the turbinate, during nasal surgeries. Turbinate tissue is not removed, limited damage is done to the mucosa, and it is not very convenient to perform this procedure under local anesthesia. Since the patient may feel pain, it is more ideal to do it under general anesthesia. After the procedure, there is an increase in the distance between the turbinate and the nasal septum. It is not destructive like turbinectomy or partial turbinate resection procedures. The fact that this procedure causes an increase in heart rate and an increase in blood pressure in patients means that care should be taken, especially in patients with hypertension or tachycardia risk. Turbinate radiofrequency is the most applied turbinate reduction process. Link where you can find detailed information about Turbinate Hypertrophy >> Turbinate Hypertrophy - Definition, Symptoms, Causes and Treatment

In this regard, I would like to add that in case of excessive reduction or surgical removal of the turbinates, there may be a change in the physiological airflow in the nose and linear, accelerated airflow may occur. The same mechanism occurs in nasal septum perforations. Links where you can find information about this condition called nasal hyperventilation >> Overreduction of Turbinate - Nasal Hyperventilation / Techniques For Reduce The Size of Inferior Turbinates

In case of excision of the turbinates in the nose and abnormal growth of the nasal volume, Empty Nose Syndrome may occur. Related link >> Why Turbinates Are Important? - Empty Nose Syndrome

Comparison of Turbinectomy and Turbinate Outfracture!

Many patients asking to turbinate removal techniques like turbinectomy or submucosal turbinate resection. I would like to emphasize here that in turbinectomy techniques, a part of the anatomically turbinate tissue is permanently reduced. That is, when the nasal air passage is excessively increased and nasal hyperventilation occurs, the probability of regrowth of the turbinates is extremely low or spontaneous regeneration of the turbinate bone is impossible. When turbinectomy is performed as excessive tissue removal, secondary atrophic rhinitis and the empty nose syndrome may occur. Turbinectomy / Turbinoplasty / Turbinate resection or whatever it is called, minimal anatomical change and minimal mucosal damage are the most important factors. The operation performed in turbinate outfracture breaks the turbinate outward and the turbinate tissue is not removed. It is less likely to cause permanent anatomical damage than turbinate resection or turbinectomy techniques. Unfortunately, there are differences of opinion among physicians on this issue.

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon

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