Long-term outcomes in medial flap inferior turbinoplasty are superior …

Long-term outcomes in medial flap inferior turbinoplasty are superior to submucosal electrocautery and submucosal powered turbinate reduction
Henry P. Barham, MD1,2,3, Mona A. Thornton, MD2, Anna Knisely, MD1,2,3, George N. Marcells, MD2,
Richard J. Harvey, MD, PhD1,2,3 and Raymond Sacks, MD, FRACS3,4

Background: Techniques for inferior turbinate reduction vary from complete turbinectomy to limited cauterization.
Surgical methods differ on the degree of tissue reduction and reliance on surgical tissue removal vs tissue ablation.
The outcome and morbidity from 3 different turbinate techniques are compared.

Methods: A randomized double-blinded study was performed. Patient nasal cavities were randomized to different interventions on each side within the same patient. One group had a combination of submucosal powered turbinate reduction (designated “submucosal”) and submucosal electrocautery (designated “electrocautery”);
and the second group had a combination of submucosal powered turbinate reduction (designated “submucosal”) and medial flap turbinoplasty (designated “turbinoplasty”). 

Patient-scored nasal obstruction and rhinorrhoea (1 to 5) along with blindly assessed nasal airway patency ratings (1 to 4) was done at 12 and 60 months postoperatively. Pain requiring additional analgesia, crusting, bleeding (needing review), and revision were documented. 

Results: A total of 100 patients were recruited (age 32.79 ± 13.58 years; 39% female). This represented 200 nasal airway surgeries with 100 submucosal procedures,50 electrocautery and 50 medial flap turbinoplasties. Nopatients complained of worsening of their obstruction. At
60 months patients in the turbinoplasty group had greateroutcomes, with 90.2% having occasional or no decongestant use (Kendall’s tau B p < 0.001) compared to electrocautery(15.8%) and submucosal (37.8%). Fewer turbinoplasty patients had a revision procedure (12%, χ2 = 20.08, p < 0.001) compared to electrocautery (54%) and submucosal (40%). Crusting was more common in the electrocautery
group (58% vs submucosal 2% and turbinoplasty 0%; χ2 = 92.04; p < 0.001).

Conclusion: Themedial flap turbinoplasty provided consistent, robust results. Long-term relief of obstructive symptoms without additional risk of complication was observed in the turbinoplasty group.