Serious Complications of a Simple Nasal Surgical Procedures: Empty Nose
Turbinate Resection With Septum Perforation Resulting In Nasal Hyperventilation And Empty Nose Syndrome
I wanted to share with you a few patient examination photos that show the importance of the inferior turbinate. The patient, who had undergone septoplasty, radiofrequency and turbinate resection twice in another clinic, applied to our clinic with the following complaints:
- sticky and solid discharge from the nasal passages
- dry and crusty discharge in the nose
- nose bleeding
- not enough air taken from the nose
- feeling of cold and dry air in your nose
- dry nose, painful areas, thick viscous discharge, more on the right side
- decreased sleep quality (turbinates may affect lying position and nasal cycle changes may also occur after turbinate procedures)
In the endoscopic nasal examination of the patient, there was a 2x1 cm nasal septum perforation and the right inferior turbinate was resected almost completely (there is only a very small turbinate tissue in the posterior part), the nasal mucosa on the right was dry and hyperemic, and the nasal mucosa on the right was inflammatory. It was observed that there were areas of dryness on the left side, only a small amount of nasal mucosa.
The reasons that are mainly responsible for so many complaints of the patient are "nasal septal perforation" and "turbinate resection".
Why Is The Nasal Mucosa So Different In The Right And Left Nasal Cavities?
In the perforation of the nasal septum, which divides the nasal cavity into two, due to the entry of air escaping from the septal hole into the nose, drying of the mucosa, crusting of the mucosa and nasal hyperventilation may occur. In addition, when turbinate resection is performed, since the diameter of the intranasal airway increases, the speed of the airflow entering the nose increases gradually, the patient's nasal mucosa may become dry and crusted, and the dry, cold and unfiltered air moves backwards and towards the lower respiratory tract. In this patient, although nasal septum perforation was present; Since there is a healthy and normal sized inferior turbinate on the left side, a limited amount of dry areas are seen in the nasal mucosa and the color of the mucosa is seen as healthy and close to pink. In the right nasal cavity, since the inferior turbinate was surgically removed; Since the accelerated air flow velocity due to septum perforation accelerates even more in a large space, and the volume of turbinate tissue that warms and purifies the air is very small, drying, crusting, hyperemic inflammation areas and inflammatory areas appear in the right nasal cavity. That is, when the turbinates are healthy and of sufficient size, even if there is a perforation in the nose; They are organs that can enlarge their own volume, increase their volume as it dries and rise, and perform the tasks of heating, purifying, humidifying and pressurizing the intranasal air. Turbinates are unique. No technology can produce a healthy turbinate tissue. They are tissues covered with a network of blood vessels inside and warm, covered with a layer of ciliated epithelium and mucus on the outside.
Similar links >> Nasal Septum Perforation - Definition, Causes, Symptoms, Diagnosis and Treatment / Turbinate Reduction Procedures / Overreduction of Turbinate - Nasal Hyperventilation / Why Turbinates Are Important? - Empty Nose Syndrome / Cool, Small, Dry Turbinate: Empty Nose Syndrome
Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon
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hi sir what will be cource of treatment will e
ReplyDeleteHello,
DeleteThank you for your contribution. Here, the patient's intranasal normal airway changes.
1. nasal septum perforation
2. overreducted turbinate (or resected turbinate)
We can planned to the firstly nasal irrigation with saline then close of nasal septal hole. Nasal septum perforation repairing surgery may helpful to reduce the nasal hyperventilation In the same nasal surgery, right inferior metal augentation with cartilage can be done. If you ask me that, can you make the same turbinate? Reproducing the turbinate tissue is impossible even with today's technology. At least, it is not possible to produce the same or similar. Narrowing of the airway in the nose and closing the nasal septal hole may be the first treatment step. I plan to keep the internal nasal silicone splints in place for about 3 months after the procedure. Washing the inside of the nose with a mixture containing rifampicin and saline can also reduce local infection.
Even a simple ansal surgery, changing the anatomy of the nose, removing tissue or damaging the existing tissue can cause very serious complaints in patients.
In some patients, we can see that the turbinate tissue is almost completely resected, with very large septum perforation. It is a very difficult situation for me to be sick indeed. You can watch on YouTube that a Chinese patient with empty nose syndrome and nasal hyperventilation slept for years using a cold steam machine and a ventilator hitting his face.
As the anatomical change increases, the treatment becomes more difficult and the patient's complaints increase.
Link group containing articles published on this website about nasal hyperventilation >> https://www.ent-istanbul.com/search?q=nasal+hyperventilation
Link group containing articles published on this website about Empty nose syndrome >> https://www.ent-istanbul.com/search?q=Empty+nose+syndrome
With greetings from Istanbul,
Assoc.Prof.Dr.Murat Enöz