Coagulation of the inferior turbinates is carried out according to strict indications. The main reason for intervention is prolonged or persistent difficulty in nasal breathing. As a rule, this is associated with the following diseases:

• chronic vasomotor rhinitis;
• hypertrophic rhinitis;
• snore;
• rhinitis medication;
• the formation of polyps in the nasal passages.

Doctors resort to surgical intervention when symptomatic and etiotropic therapy does not give results.

Exposure to high-frequency waves provokes the evaporation of fluid from the cells of the mucous epithelium. As a result, the vascular network disappears, and the mucous membrane of the inferior turbinates becomes thinner. The operation allows to restore normal breathing of the patient in case of hypertrophied epithelium and chronic swelling of the mucous membrane. The technique is considered the safest and most effective in ENT practice, and due to the speed of implementation and a short period of rehabilitation, it is the most acceptable for the patient. The final result is noticeable after a month.

In the medical center "Best Clinic" coagulation of the inferior turbinates is carried out using the American apparatus "Surgitron". Intervention takes no more than an hour.

Operation procedure:

1. Training. The doctor conducts application anesthesia with a solution of Lidocaine applied to the turunda to anesthetize the mucous membrane. After that, infiltration anesthesia is performed - two injections into the anterior and posterior thickness of the turbinate. In this case, the patient feels only a bursting and numbness of the nose, there is no pain. Anesthesia lasts 3-4 hours.
2. Operation. An electrode is inserted into the inferior turbinate. Depending on the degree of hypertrophy, the doctor chooses the intensity and duration of the radio wave exposure. It usually lasts 10 to 20 seconds. Possible sensations are a slight burning or tingling sensation in the nose.
3. Completion. After the main stage, the doctor inserts tampons into the nasal passages. They prevent excessive swelling of the mucous membrane and possible bleeding. After a day, the patient can remove them on their own or go to the clinic.

After removing the tampons from the nose, postoperative edema of the mucous membrane persists. At this time, moderate painful sensations are possible. Nasal breathing is difficult for 3-4 days. After that, the swelling begins to gradually subside.

The complete rehabilitation process can take 1-2 weeks, depending on the individual characteristics of the organism. During the recovery period, the patient needs to regularly visit the clinic so that the doctor can clear the mucous membrane from fibro-necrotic plaque (crusts). The exudate of the damaged mucosa has a high adhesion ability. Neglect of professional treatments is fraught with the formation of adhesions. After 2 weeks after the operation, the edema disappears completely, and the person can breathe freely through his nose again.

Before the coagulation procedure, the doctor takes a thorough history. The reasons for refusing to intervene may be:

• oncological diseases;
• acute stage of viral respiratory infection;
• epilepsy;
• period of pregnancy;
• diabetes;
• installed pacemaker;
• hepatitis;
• cardiovascular failure.

During the intervention, ultra-high temperatures are used. They guarantee complete sterility of the procedure and exclude the addition of infection.

Among the consequences of the intervention are temporary edema of the mucous membrane and the possibility of the formation of minor scars on the epithelium after complete healing.

For two weeks after coagulation, you should refrain from intense physical activity. During this period, a measured and calm lifestyle is desirable, without overwork and nervous overstrain. If the patient's professional activity is related to communication with people, it is better to plan the operation for the period of vacation.

You should not independently remove the crusts formed during tissue healing. This additionally injures the mucous membrane, increases the risk of bacterial infection, the formation of adhesions or scars. The need to use any medication should be discussed with a doctor.

Sometimes a person has such problems in the nose that it is impossible to cope with them with the help of drugs alone. In such cases, the otolaryngologist prescribes cauterization of the turbinates. It is made by different methods - chemical and laser. What are the advantages of the method? What are the consequences of the operation? The patient needs to know where he is going when he agrees to such a procedure.

What is nasal coagulation

With a chronic rhinitis, the patient's nose expands. This disrupts the ability to breathe normally, you have to constantly use drops, but their action is of little help. The goals of the operation are to reduce the hypertrophied mucous membrane, get rid of chronic rhinitis and normalize breathing.

With the help of cauterization of the nasal sinuses, the network of vessels that are located between the bones and the epithelium is evaporated. The procedure is carried out using a laser or chemicals such as silver. The method is safe, the risk of infection is minimized.

Indications for coagulation

The doctor can prescribe a cauterization of the nose in the presence of such indications:

• Chronic rhinitis refractory to drug treatment.
• The formation of hypertrophic changes in the nasal membranes as a result of the frequent use of vasoconstrictor drugs.
• The inability to breathe freely without the use of nasal drops, drug dependence.
• Frequent nosebleeds.

The main condition for moxibustion is the expansion of the turbinates, and not another pathology.

Contraindications

This procedure has contraindications:

• Exacerbation of chronic inflammation in the sinuses and in the respiratory system as a whole.
• Low blood clotting.
• In women, surgery is not performed during menstruation.

Moxibustion should not be done when there is a risk of bleeding. High blood pressure and fever are also contraindications.

Preparing for surgery

Before the operation, the doctor must inform the patient about how the procedure will be carried out and what its consequences are.

For women, a few days before the operation, it is necessary to stop using cosmetics and cosmetic procedures.

It is necessary to pass a number of tests to determine the general picture of the blood, the patient's condition and the presence of infection. After that, the date of the operation is set. All this time, you can not take alcohol and drugs that thin the blood.

How is the procedure performed

Before laser cauterization of the nasal mucosa is performed, blood pressure and temperature are measured. The patient is informed once again about the benefits of the method, the course of the operation and possible side effects. Here's how it should work:

• If the clinic is private, the patient is dressed in a disposable gown and shoe covers. Personal clothing is removed. Transferred to the operating room.
• Any normal person gets anxious before surgery, even if it is minor. It is the responsibility of the medical staff to talk to the patient, to distract him so that he calms down. If this does not help, the doctor will prescribe sedatives.
• The patient is placed on an operating couch with a raised head edge.
• During surgery, the patient must be completely motionless. Therefore, he should initially take a comfortable posture.
• A bandage is put on the eyes so that the patient is not intimidated by the sight of the surgical instruments.
• If the patient agrees, the arms and legs are fixed with bandages so that he does not accidentally touch the surgeon. This can cause burns to the nasal cavity.

During the procedure, the patient breathes through the mouth. This isolates it from unpleasant odors. In addition, the vapor emitted from the laser contact will not enter the lungs.

• The operation is painful and therefore requires pain relief. To do this, an injection is given or cotton turundas moistened with a special agent are inserted into the nose for a few minutes.
• The patient's face is treated with 70% diluted medical alcohol to avoid infection.
• In order to localize the violation of the mucous membrane, this place is tinted with methylene blue. It will perform a double function - it will indicate the location and improve the laser action.
• The doctor needs to laser the front end of the nasal concha. All other surfaces remain intact. The whole process is controlled by an endoscope or a special mirror. Normally, the patient does not feel pain, only a slight tingling sensation.
• The doctor is watching his actions in the monitor. Laser touches are carried out in the form of single points or continuously.

After the procedure, a cotton swab is inserted into the patient's nose and taken out of the operating room.

Consequences and complications

Cauterization of the vessels in the nose is a surgical procedure. And if you do not follow the recommendations of experts, it can provoke side effects. These include:

• Atrophic changes in the mucous membranes of the nasal sinuses. This leads to disruption of the normal functioning of the epithelium. Pathology is rare.
• Inflammation of the mucous membranes. It rarely occurs. Poor disinfection adherence and medical negligence may be the reasons. The apparatus and instruments must be sterile.
• Impaired sense of smell or complete loss. This condition is temporary, it arises from the internal edema of the site of operation.

After healing, everything is restored. If this does not happen, the patient must inform the doctor about it.

• Great feeling of congestion in the nasal passages, making breathing difficult. Usually, everything goes away with time, but a relapse of hypertrophic phenomena is possible. May be related to allergies.

To avoid such phenomena, you must strictly follow all the doctor's prescriptions.... In cases of deviations from the norm, you need to seek help.

Cauterization with silver

Cauterization of the nose is carried out not only with a laser, but also with a chemical agent. One of the methods is cauterization with silver nitrate. This is a remedy that has a strong cauterizing property and is used to treat various skin pathologies, including papillomas and warts. It is also successfully used in otolaryngology.

The indication for such a procedure is from the anterior part of the nose. But on condition that the blood flows slightly and stops easily. This means that a small vessel has ruptured somewhere in the nose, and it needs to be stopped so that the bleeding stops.

Order of manipulations

The procedure is carried out as follows:

• A vasoconstrictor is instilled into the nasal passages to eliminate swelling and reduce discharge.

Dry nasal passages do not allow the cauterizing agent to spread and exclude the occurrence of burns.

• Anesthesia is carried out with irrigation with special means or with an inserted cotton swab dipped in anesthetic.
• Spot cauterization is done with silver nitrate.

The solution for moxibustion must be strong - up to 50%. Recently, doctors have been practicing applying silver nitrate not to the bleeding vessel itself, but around it, so as not to provoke even more bleeding. This makes the result better.

Side effects

Cauterization with silver does not pass without consequences for everyone. Sometimes such phenomena occur:

• Burning in the nose, sneezing and profuse lachrymation.
• After the procedure, the nose remains stuffy for some time. Over time, everything will return to normal.
• In rare cases, the sense of smell may be temporarily impaired.

If you experience these symptoms, you should consult your doctor. Sometimes such moxibustion is recommended for the treatment of rhinitis. But it is better to use other methods, while there is a risk of burns that injure healthy tissue.

Benefits of Laser Moxibustion and Silver Moxibustion

Cauterization with a laser has its advantages:

• dressing is not performed at the site of surgical procedures;
• no bleeding occurs;
• there is no rupture of blood vessels, they are sealed and cauterized;
• short holding time, no more than ten minutes;
• the wounds remain small, insignificant;
• a high percentage of complete recovery of the nasal mucosa, up to 96%;
• does not require general anesthesia;
• after the operation, the patient recovers quickly.

Silver cauterization is also more effective than older methods used in the past..

The moxibustion procedure is painful, but quite effective in the fight against annoying rhinitis. It can be done at different ages, but taking into account all the contraindications.

To carry out RF / radio wave submucosa optically (video) endoscopic reduction / coagulation of the inferior turbinates, you need:

You can take tests anywhere- in a polyclinic at the place of residence, having previously applied for referrals to a local doctor - therapist, or in any private laboratory.

To save your time, the test results (in the form of a scanned or photographed image), together with patient data and a phone number for feedback, are sent to e-mail ( [email protected] / [email protected]) or Viber / WhatsApp / iMessage (+ 7-912-938-04-88).

The date of the operation is determined after you have sent me the test results, usually the day and time of the operation are agreed with the patient individually.

Before getting tested, ask the doctor by e-mail about the schedule of operations - the schedule may change - I may be on vacation, on sick leave, and so on.

After I receive the test results and analyze them, within 24 hours, in a response e-mail in the attachment, I will send you all the documents necessary for hospitalization (referral with the date of surgery, necessary recommendations, consent, etc.) with a request to carefully read them. and the next day I will call you back and answer all your questions. After that we will meet on the day of the operation.

If the test results are unsatisfactory, I will call you back shortly after receiving them and notify you that it is impossible to carry out the operation.

The operation is carried out outpatient (without round-the-clock hospitalization).

The doctor uses the ENT radio wave apparatus for persistent obstruction of nasal breathing, as well as in the absence of the effect of vasoconstrictor drops in the nose, for diseases such as chronic vasomotor rhinitis and chronic hypertrophic rhinitis, as well as for snoring (ronchopathy).

Using a radio wave apparatus, an ENT doctor performs an operation - radio wave coagulation of the inferior turbinates. This medical ENT manipulation is a minor surgical operation, one of the advantages of which is the ability to operate on a patient without hospitalization (on an outpatient basis), and a short period of rehabilitation and recovery after surgery, due to not so pronounced edema of the mucous membrane of the lower nasal concha, allows you to safely give preference to it. and put it first when compared to other surgical treatments.

The operation takes no more than 1 hour, and most of the time is spent on "preparation" (anesthesia). First, the ENT doctor performs local application anesthesia by placing a cotton swab moistened with a solution of dicaine with adrenaline into the nasal cavity. Then the ENT doctor conducts local infiltration anesthesia, making injections (injections) of Ultracaine DS-forte into the thickness of the inferior turbinates.

For high-quality and adequate pain relief, it is recommended to perform two injections into each inferior turbinate. At the same time, the patient practically does not feel the injection of the needle, but can feel a slight tension of the tissues, due to the "expansion" of the drug in the anterior parts of the inferior turbinate.

The action of the drug is instantaneous, and the effect of anesthesia lasts about 3 - 4 hours, which makes it possible to operate on a patient with high-quality anesthesia.

The patient does not feel the second injection, since it is essentially a conductive anesthesia, through the anterior to the posterior parts of the inferior turbinate. Then the ENT doctor allows the patient to tune in to the operation, while the effect of drugs is gaining full strength.

The doctor conducts radio wave coagulation of the lower nasal conchas by inserting an electrode into the thickness of the lower turbinate for 3 - 5 - 10 - 20 seconds, depending on the severity of the chronic process.

Another important advantage of this ENT operation is the 100% sterility of this method. This is achieved due to the fact that when you press the pedal and apply a radio wave to the electrode, after 1 millisecond everything living (bacteria, fungi, viruses, vibrios, spirochetes, protozoa and other microorganisms), which is located on the metal spokes of the electrode, (working surfaces ) dies, not withstanding ultra-high temperatures. At the same time, it is important that the ENT patient does not have a cold and does not get sick at the time of the operation with such diseases as: acute respiratory infections, acute respiratory viral infections, sinusitis, pharyngitis, tonsillitis, laryngitis, bronchitis, tracheitis, pneumonia and other acute and chronic bronchopulmonary diseases. This guarantees the ENT patient the "sterility" of this operation.

With direct radio wave exposure, the patient either does not feel anything, or feels a slight, but very tolerable burning or tingling sensation in the nose. Due to the high speed of radio wave exposure, all negative sensations of the patient are minimized.

Another great advantage is the so-called controllability of this operation, since the ENT doctor has the ability to set the required frequency of exposure. In fact, this is the strength of the effect of radio waves on the tissues of the human body. Also, the ENT doctor has the ability to adjust the exposure at his own discretion, that is, the duration of exposure.

The most important and useful condition is that the ENT doctor has the ability to suspend the operation at any time or stop it altogether. Unfortunately, today this is not possible with all operations, including those on ENT organs.

After surgery on the lower turbinates, the ENT doctor places (can install) cotton swabs into the nasal passages in order to avoid possible bleeding and prevent the development of severe edema of the operated nasal mucosa.

The patient, if necessary, removes cotton swabs on his own the next morning after the operation, or can go to the clinic where the operation was performed. 10-15 minutes after removing the tampons, postoperative edema of the tissues of the inferior turbinates and the nasal mucosa develops.

The patient's nasal breathing will be uncomfortable for 3 to 4 days after the operation, then the swelling of the nasal mucosa will gradually decrease, and nasal breathing will be restored.

Another important point in the postoperative course is the formation of "crusts" that impede and impede nasal breathing. The so-called "crusts", or if it is correct, "fibrinous-necrotic plaque", are formed on the 3rd - 4th day after the operation, as a protective layer covering the operated area. At the same time, the nasal cavity needs a thorough toilet (cleaning), since this plaque tends to glue the mucous membrane of the operated inferior turbinate with the mucous membrane of the nasal septum. Thus, synechiae (adhesions) may form, which in turn will also need to be dissected, preventing the development of an adhesion process.

The ENT nasal toilet is / can be performed by the doctor every day or every other day, but only in the clinic with sterile instruments. The patient will not be able to remove the "crusts" from the nose on his own, due to their deep location and their high adhesive capacity. On average, the patient comes to the clinic after surgery for the toilet of the nose 2 - 4 times. It all depends on the mechanisms of regeneration and the reparative capacity of the human body.

It is possible to reliably assess the effect and quality of the ENT operation performed only after a month, since only by this time the mucous membrane of the inferior turbinates will fully recover.

LOWER NOSE REDUCTION - it is an operation to improve nasal breathing.

LOWER NOSE REDUCTION Is a painless radiofrequency effect on the submucosal structures of the lower turbinates in order to reduce them and restore nasal breathing.

The most common diagnosis / condition in which the REDUCTION OF THE LOWER Nasal Conchas is carried out is vasomotor / vasomotor-allergic / drug-induced rhinitis in the phase of vasodilation with an increase in the volume of the lower turbinates.

The radiofrequency effect of the bipolar electrode causes excessive locally limited heating in the thickness of the cavernous / erectile tissue of the inferior turbinates, which in turn creates cicatricial changes in it. For up to about 6 weeks after surgery, the result of RADIO FREQUENCY REDUCTION is a gradual reduction in the size of the inferior turbinates.

Typical possible but optional accompanying symptoms, complaints and conditions associated with the operation after returning home:

– NOSE TAMPONADE. Rarely, but there is a need for anterior nasal tamponade. In such a situation, you can remove them yourself a few hours at home after the operation, and you can also come to the clinic the next day and they will be removed by the doctor.

- PAIN. There may be some feeling of pressure and discomfort in the nose, "itching", nasal congestion after surgery. You can take painkillers / anti-inflammatory drugs (nimesil, paracetamol), drugs based on ibuprofen, aspirin are not recommended.

FIRST WEEKS AFTER THE SURGERY:

NOSE REMOVAL or small drops of blood from it are possible within the first 24–48 hours after surgery. You can carefully start blowing your nose after 5 - 7 days. When you blow your nose, your nasal discharge may be bloody and crusty. This can take up to 4 weeks. Vigorous / vigorous blowing should be avoided as it may cause bleeding. A little fresh blood on the handkerchief, "spotting" on it is not a cause for concern, even for up to several weeks after the operation. Don't worry, this is normal.

- DRY IN THE NOSE. The nose may be dry and stuffy for several weeks. There may be a feeling of a severe runny nose. For relief / elimination of this symptom, it is recommended to use the drug "Moreal plus spray" up to 6 times a day or more as needed. Vasoconstrictor drops (for example, "Afrin") can be used only with a sharp excessive difficulty in nasal breathing, without being carried away by them.

- BLEEDING. If in the postoperative period you notice nosebleeds, you can use any vasoconstrictor drops based on oxymetazoline (Afrin nasal spray, etc.), or moisten a cotton ball from a spray bottle and insert it into your nose for 15–20 minutes.

- Sit in a chair and relax. DO NOT lie down !!! - Squeeze your nostrils tightly with your thumb and forefinger. You can use ice - put it in a plastic bag, add a little water, and hold the bag tightly to your forehead and bridge of your nose. If the bleeding continues for a long time (more than 30–45 minutes), despite the efforts made to stop it, if you start to feel a worsening of the condition, call me or call an ambulance, tell the EMS doctor that you have had a reduction of the inferior turbinates.

PLEASE also call me if there is a purulent discharge from the nose and / or a temperature above 38 degrees 5-7 days after the operation.

PHYSICAL ACTIVITY... You can resume your normal activities if there are no signs of bleeding for 72 hours after surgery.

- Limit physical activity, lifting weights, going to the fitness / gym for 2 to 3 weeks.

- Limit sexual intercourse to 2 to 3 weeks.

- Avoid baths / saunas / hot tubs / hot showers for the next 3-4 weeks after surgery, as this increases the risk of bleeding.

- During the first day, it is advisable to sleep with your head elevated - this will help minimize the risk of bleeding, pain and nasal congestion.

- Avoid tilting the body and head downward for lifting things / tying shoelaces / shoveling, etc. - this will help to minimize the risk of bleeding.

FIRST MONTH AFTER OPERATION... Within a month, your nasal breathing may not be ideal. You may experience mild, transient discomfort. In general, each day after surgery will be better than the previous one. Remember that your recovery is not the fastest process and largely depends on the regenerative capabilities of your body.

LOWER NOSE REDUCTION is effective in more than 85% of patients.

THE SURGERY IS AMBULATORY AND DOES NOT REQUIRE HOSPITALIZATION.

After the operation, you leave the clinic on the day of the intervention.

PREPARATION FOR OPERATION:

- You should NOT take pain relievers / anti-inflammatory drugs (nurofen, aspirin, paracetamol, ibuprofen, etc.) for the week before surgery.

- For 3 days before the operation, be sure to use vasoconstrictor nasal sprays at least 3 times a day.

FOOD AND DRINK BEFORE OPERATION

- You can and should eat well before the operation, drink sugary non-alcoholic drinks (for example, weak tea with sugar). Do not come to the operation hungry !!!

SPECIAL PREPARATIONS

- If you are constantly taking any drugs all the time, consult with the surgeon about the possibility of using them on the day of the operation.

OTHER MEDICAL PROBLEMS AND ASSOCIATED DISEASES

- You are obliged to inform the ENT operating doctor about your heart problems, mitral valve prolapse in the presence of existing problems, problems with blood pressure, blood vessels, joints, kidneys, etc. This may be a reason for prescribing antibiotic therapy prior to surgery and even canceling the operation.

–For girls of fertile age: the operation is performed after the end of mensis, it is undesirable to carry out the operation 3-5 days before the onset of mensis due to the high risk of postoperative bleeding.

ACTUAL TIME OF OPERATION usually does not exceed 15 - 30 minutes. It can be performed both under local anesthesia and under general anesthesia.

HELP IN TRANSPORTATION AFTER OPERATION

- If the procedure is performed on an outpatient basis, then we strongly WE DO NOT RECOMMEND you to get behind the wheel on the first day after surgery. Make sure to be taken home. Do not use public transport.

SCHEDULE OF OPERATIONS.

- By e-mail or by phone after interpreting the results of the tests you sent, you will be informed about the time and date of the procedure.

SHOULD I perform this operation on myself?

No. The decision on the need for the operation is made by you. This is a palliative / optional surgery.

IS THERE AN ALTERNATIVE?

Not unless a 2–3 month course of topical corticosteroid medications has helped you. Vasoconstrictor drops and spray are not recommended for more than 2 weeks. Use them for a long time - the swelling of the turbinates may be more pronounced.

WHAT WILL CHANGE AND BETTER AFTER THE SURGERY?

Your nose will breathe better (after a while) after the surgery.

WHAT WILL NOT CHANGE AFTER THE SURGERY?

- All other symptoms (sneezing, itching in the nasal cavity, rhinorrhea, impaired sense of smell, etc.).

WHAT WILL HAPPEN IF I DO NOT PERFORM THE SURGERY?

- Nasal breathing will remain defective. It may worsen even more.

WHAT ARE THE LONG-TERM PERSPECTIVES OF THE SURGERY?

- In the overwhelming majority of cases, it is possible to guarantee normal nasal breathing for decades after the operation, less often the swelling can return several years after the operation. Lifetime guarantees cannot be given.

WHAT DRUGS MAY NEED AFTER THE SURGERY?

- Moisturizing, anti-inflammatory and vasoconstrictor sprays, topical corticosteroid drugs.

WHAT CAN GO WRONG AND WHAT CAN YOU DO IN THIS CASE?

- Lack of an adequate response to the anesthetic drug, pain during surgery. In this case, it is recommended to carry out the operation under general anesthesia. The operation can be stopped at any time.

- Removal of excess tissue and the formation of more crusts than usual. In this case, you may have to visit the clinic up to 2 - 4 times after the operation to control tissue regeneration, remove excess crusts in the nose.

WHAT SERIOUS COMPLICATIONS ARE POSSIBLE IN THE PROCESS OF ANESTHESIA AND OPERATING INTERVENTION?

- You may have recurring bleeding, you may need a nasal tamponade, you may need to re-intervention, up to a blood transfusion. More serious complications are statistically extremely rare. All surgical interventions and anesthetic management have certain risks that are similar in everyday life and are comparable to flying on an airplane on vacation, driving a car, etc.

WILL I HAVE BLACK CIRCLES UNDER EYES OR VISIBLE SCARS AFTER THE SURGERY?

One of the main causes of chronic nasal congestion is the pathology of the inferior turbinates.
However, today there is no consensus among specialists in solving this problem.

Pharmacological treatment is generally the first choice. In many cases, nasal topical steroids, antihistamines, and decongestants work well.
Surgery to reduce the turbinate is usually prescribed for patients who do not respond to this treatment.

Since the last quarter of the 19th century, at least 13 different technologies have been introduced. Some of them have already been discarded, while others are still in use or have been re-implemented.
There is, however, considerable disagreement about the merits of different technologies (Jackson and Koch, 1999).

Some authors view conchotomy as the most acceptable treatment, while others condemn it as too aggressive and irreversibly destructive.
Another controversial technology is laser treatment. Although a number of authors have recently defended this technique, many rhinologists do not approve of it, since the laser destroys the mucous membrane and consequently reduces its functioning.

Functions of the turbinates

Inferior turbinates- These are bony protrusions on the side walls of the nose, covered with a mucous membrane with a developed submucous layer. Numerous venous plexuses lie in the submucous layer.

The turbinates, especially the inferior ones, have several important functions:

Firstly, they promote inspiratory resistance, which is necessary for normal breathing. The greater the nasal resistance, the greater the negative intrathoracic pressure required for inhalation. Large negative pressure, in turn, enhances pulmonary ventilation and venous return to the lungs and heart (Butler, 1960; Haight and Cole, 1983).

Secondly, As part of the nasal valve, the inferior turbinate helps to convert inspiratory airflow from laminar to turbulent. Turbulence in the outer layers of the air increases the interaction between the air and the nasal mucosa. This improves humidification, warming and air purification. Due to the large surface of the mucous membrane and extensive blood supply, the inferior shells play an important role in this process.

Thirdly, they are important in the defense system of the nose (mucociliary transport, humoral and cellular defense).

All these functions require a large amount of normally functioning mucous membrane, submucosa and parenchyma of the shells.
An increase in the blood filling of the venous plexus, for example, in acute viral rhinitis, causes swelling of the shells. Because of this, the lumen of the nasal passages narrows, breathing through the nose worsens. Constant enlargement of the turbinates is a key problem with different types of rhinitis - medication, vasomotor, allergic and others. The venous plexus in these conditions is constantly overflowing with blood.

Why can't you just remove the turbinate?
The inferior turbinate cannot be removed. The feeling of full breathing depends not only on the width of the space through which the air passes. The mechanism of perception of an air stream by the human senses is generally poorly understood. Surgical transection of the trigeminal nerve fibers may result in a feeling of nasal congestion with sufficient lumen of the nasal passages.
At the same time, under the action of menthol, there is a feeling of improved breathing, although the lumen of the airways does not increase.
Complete removal of the turbinate often paradoxically does not improve nasal breathing. Moreover, the person may feel that breathing has deteriorated.
The trajectory of the air stream is changing for the worse, chronic inflammation develops, and crusts are constantly formed. This means that the operation should reduce the volume of the shell, but preserve its shape and mucous membrane. Complete removal of the organ is unacceptable.

ENT DICTIONARY
Ablation- removal, clipping.
Vasotomy- a section of the vessel.
Disintegration- destruction.
Destruction- destruction.
Coagulation- moxibustion.
Conchotomy- cutting off part of the shell.
Conchopexy- fixation of the shell.
Reduction- decrease in volume.
Resection- partial removal.
Turbinoplasty- plastic surgery of the turbinate.
The names "destruction", "reduction", "disintegration", "vasotomy", "coagulation" in relation to the lower turbinates are often used interchangeably.

The main methods of reducing the volume of the turbinates

All methods of operations on the turbinates are assessed mainly according to two criteria:
The effectiveness of the technology in reducing breathing difficulties, hypersecretion and other patient problems caused by increased turbinate volume;
Side effects that occur in the near and long term or the degree of preservation of the functional tasks of the nose.

Treatment methods for hypertrophy of the inferior turbinates

Method	Other names	Year of introduction	Acting factor	Method essence	Use	Left-flax
Thermal coagulation	Galvano-caustics, electro-caustics, electro-coagulation	1825-80	Constant current heating probe	Cauterization of tissue with a red-hot probe	+
Ultrasonic disintegration	Ultrasound, ultrasound destruction, ultrasound vasotomy		Ultrasound	Destruction of tissue by ultrasound	+
Radio wave (radio frequency) coagulation	Radio wave destruction, radio wave reduction, radio wave vasotomy		High frequency alternating current generating radio waves	The passage of radio waves through the tissue causes it to heat up and destroy	+
Laser surgery	Laser coagulation, laser conchotomy, laser vasotomy, laser reduction	1970	Laser radiation	Heating and destroying tissue with a laser beam	+
Submucosal vasotomy			Mechanical destruction	Manual destruction of the submucosal plexus with a surgical instrument	+
Conchotomy	Resection	1850		Removing part of the turbinate manually without preserving the mucous membrane	+
Lateralization	Lateropexy, conchopexy	1904		Displacement of the turbinate to the side wall of the nose manually with a surgical instrument	+
Crush + alignment, partial resection		1930–1953			+
Shaver (micro-debrider) destruction	Shaver conchotomy, shaver vasotomy, shaver reduction, turbinate reduction using electromechanical instruments	1994		Removal of a part of the nasal concha with an electromechanical instrument with or without preserving the mucous membrane	+
Turbinoplasty		1950		Removal of part of the turbinate manually while preserving the mucous membrane	+
Cryodestruction	Cryosurgery	1970	Low temperature	Freezing tissues with their subsequent destruction		+
Chemical coagulation, chemocaustics		1869–1890			+
Corticosteroid injections		1952				+
Sclerotherapy injections		1953				+
Vidioneurectomy		1961				+

Thermal coagulation - electrocaustics

The first method for the treatment of hypertrophied inferior turbinates was electrocaustics.
Superficial electrocautery is clearly a destructive procedure. It causes mucosal atrophy, metaplasia, loss of cilia, and decreased mucociliary transport. Permanent crusts, synechiae between the nasal septum and the turbinates may form. Although these undesirable effects are known, it remains one of the most commonly used methods in practice.
Coblation ("controlled ablation") is a very recently introduced method of high frequency bipolar diathermy. Since the result is achieved at low temperatures, damage to the surrounding tissue is minimized. A "cold" plasma field is formed around the active instrument. Ions in this field have sufficient energy to break the bonds of organic molecules in soft tissues at relatively low temperatures of 40-70 degrees.
Intracranial coagulation.
Since superficial electrocautery causes significant damage to the mucous membrane, intra-canal thermocoagulation was introduced.

Ultrasonic destruction.

The method of ultrasonic destruction (USL) of the turbinates was invented by Soviet scientists Ferkelman and Vinnitsky in the early 70s.
During the operation, the surgeon inserts an ultrasound probe into the nasal concha. Exposure to ultrasound leads to limited destruction of the submucosal layer. The turbinate decreases.

Radio frequency (radio wave) coagulation.

The history of high-frequency electrosurgery (radiosurgery) began in the first half of the 20th century. The first efficient high-frequency generator was created by Bowie in 1926.
The essence of the method: a probe is inserted under the mucous membrane of the shell. As a result of the action of alternating current, radio waves are generated, heating the surrounding tissue, due to which it is destroyed. The venous vessels of the submucosal layer become empty, the shell decreases in volume.
The difference between radiofrequency surgery and electrocautery is that during electrocautery, the probe itself heats up, it burns the tissue like a "hot iron". During RF coagulation, the tissues around the probe are heated by resistance to the radio wave.

Laser surgery

Laser destruction of the turbinates entered medical practice in the late 70s of the last century.
During the operation, the light guide is inserted into the nasal concha. The energy of the laser beam causes the tissue under the mucous membrane to evaporate, which leads to a shrinkage of the organ.
Laser technology can be used to perform partial conchotomy and intraturbinal tissue reduction. The laser can be used where a knife or scissors are commonly used.
Turbine laser surgery can be performed under local anesthesia on an outpatient basis. The hemostatic properties of laser exposure are such that postoperative bleeding is very rare and nasal tamponade is not needed. However, temporary crusts are common, and synechiae may also occur.
Published data on laser turbinate surgery results vary widely (from "43% success" to "excellent results").
Some experts believe that laser turbinate surgery does not meet the requirement for “optimal volume reduction combined with preservation of function”.
With limited evaporation of the mucous membrane and submucosa, the volume of reduction is clearly insufficient.
If the volume to be removed is sufficient, then the functional changes are severe and irreversible. Therefore, laser surgery is not compatible with the current concept of functional nasal surgery and should not be used to treat hypertrophied inferior turbinates.

Submucosal vasotomy

Submucosal vasotomy of the inferior turbinates consists in purely mechanical destruction of the vessels under the mucous membrane (dissection of the vascular collaterals between the periosteum of the turbinates and the mucous membrane).
Due to this and subsequent cicatricial changes in the nasal mucosa, the latter is reduced, the swelling of soft tissues is stopped, the turbinates contract, which ultimately leads to an improvement in nasal breathing.
In general, any submucosal destruction of the nasal concha vessels, whether laser or ultrasound, can be called a vasotomy. Vasa is a vessel, -tomia is an incision, dissection. Thus, vasotomy means "cut through the vessel." So they say sometimes: laser submucosal vasotomy.
But when the text simply says "submucous vasotomy", without specifying definitions, it usually means that the destruction was performed by an instrument that does not have any other effect than mechanical destruction. For example, a surgical chisel.

Conchotomy

Conchotomy - removal of part of the shell together without preserving the mucous membrane. Nowadays, surgeons in some cases practice posterior conchotomy.
The hypertrophied posterior ends of the turbinates are cut off with scissors.
Conchotomy has been discredited; many surgeons preferred more conservative techniques such as lateralization and submucosal resection. However, total conchotomy was again recommended by several authors in the 1970s and 1980s (Fry, 1973; Courtiss et al., 1978; Martinez et al., 1983; Pollock and Rohrich, 1984; Ophir et al., 1985; Odetoyinbo, 1987; Thompson, 1989; Wight et al., 1990).
Recurrent nasal congestion has already been reported (Otsuka et al., 1988; Wight et al., 1990; Carrie et al., 1996). In addition to the long-term consequences, it is necessary to take into account early complications, especially severe bleeding (Fry, 1973; Dawes, 1987).
According to some well-known specialists, in patients with hypertrophy of the inferior turbinate, total or subtotal conchotomy is not justified.
Conchotomy is incompatible with the "preservation of function" task. Conchotomy is irreversible and deprives the nose of one of its important organs. Thus, there is no place for this technology in modern functional nose surgery.

Lateralization, lateropexy

In response to the side effects of conchotomy, Killian proposed lateralization (lateral displacement) of the inferior turbinate in 1904.
The shell was fractured and displaced laterally by a flat elevator or a nasal mirror with long branches. This procedure is simple and has no particular risk or complications (Salam and Wengraf, 1993).
On the other hand, it does not seem to be particularly effective. Lateralization is well done when the inferior nasal passage is wide enough to move the inferior concha.
Otherwise, it tends to return to its former position (Goode, 1978). Lateralization is an acceptable technique for maintaining function. As its effect is limited, it can be used as an adjunct procedure, for example in combination with septum surgery.
Lateropexy (or conchopexy) involves the movement of a fractured shell into the maxillary sinus after removal of a portion of the lateral nasal wall (Fateen, 1967; Legler, 1974, 1976). This method has not gained much popularity.

Crush and Align - Partial Resection

The long-term complications of total turbinectomy have convinced most rhinosurgeons that partial resection of the inferior turbinate would be the best choice.
Several technologies have been proposed - trimming, horizontal and diagonal resection of the inferior margin; posterior resection and anterior resection.
In 1930, Kressner introduced shell crushing with specially designed blunt forceps and then flattening.
Resection of the posterior end of the turbinate was proposed, among others, by Proetz (1953), since he believed that in most cases it is the posterior half of the inferior turbinate that causes difficulty in nasal breathing.
Goode (1978), Pollock and Rohrich (1984), Fanous (1986) and many others advocated resection of the anterior inferior turbinate. Unlike Proetz, they viewed the turbinate head as the most frequent obstruction to breathing.
A horizontal lower lower margin resection was recommended by Courtiss and Goldwyn (1990), Dessi et al. (1992), Ophir et al. (1992) Percodani et al. (1996). This technique avoids the risk of bleeding from the pterygopalatine artery (Garth et al., 1995).
Spector (1982) proposed a diagonal resection of most of the turbinate. This method preserves the functionally important head of the inferior turbinate.
From the point of view of preservation of function, all of the options for partial turbinectomy discussed above seem to be acceptable if they are performed in a sparing manner.
In our opinion, the concha head resection seems to be too destructive. It can eliminate anterior obstruction, but partially deprives the nose of its resistor and diffuser functions.
Resection of a portion of the posterior end of the turbinate appears to be functionally acceptable, but it is effective only in patients with pathology limited to the turbinate tail.

Shaver destruction

Shaver destruction of the turbinates is a surgical operation using a special instrument called a shaver (microdebrider). Shaver conchotomy is one of the synonyms for this operation.
In the English speaking world there is a term “powered turbinate reduction” for shaver operations. Sometimes in Russian texts one can find such a translation of it: "reduction of the turbinates using electric instruments." This usually means that a shaver (microdebrider) is involved in the operation.
These instruments are used both on the surface of the shell and intraturbinally, often in combination with endoscopic guidance. They are said to be able to accurately remove soft tissue.
Shaver is a rotating blade paired with an electric pump. The tissue to be removed is immediately sucked into the interior of the device. Some surgeons cut off portions of the concha from the lateral and inferior margins, while others shaver within the concha (Friedman et al. 1999; Van Delden et al. 1999). This technology is said to be fast, effective, well tolerated and not painful (Davis and Nishioka, 1996).
The use of power tools is determined by personal taste. It depends little on the type of instrument. It is more of a surgical technique than a measure of the volume of turbinate reduction.

Turbinoplasty

In the 1980s, the term "turbinoplasty" was introduced (Mabry, 1982, 1984). It combines various intraturbinal methods of surgical reduction of the inferior turbinate while preserving the mucous membrane.
Turbinoplasty involves removing part of the turbinate while preserving the mucous membrane. An incision is made in the mucous membrane from the functionally inactive side of the organ, which faces the wall of the nasal cavity. Through this access, part of the nasal concha tissue is removed, and the mucous membrane is put into place. When the resection of the bone and parenchyma is limited to the anterior part of the turbinate, one speaks of "anterior turbinoplasty". This technique is used in patients with inspiratory respiratory obstruction due to turbinate hyperplasia. Another technique is "partial lower turbinoplasty". With this technique, two separate incisions are made, connecting in the center of the shell. The wedge-shaped portion of the shell is then removed and the edges of the resulting defect are brought together (Schmelzer et al. 1999). Intracranial turbinoplasty allows for size reduction while maintaining all mucosal functions, as recently demonstrated by Passali et al. (1999) in a comparative study. Its second advantage is the low likelihood of postoperative bleeding and crusting. In terms of “optimal volume of reduction with preservation of function”, intracancerous turbinoplasty is the method of choice in the treatment of turbinate hypertrophy. This is a tissue-shrinking procedure, but it can be modified according to the pathology without considering the function of the mucous membrane.

Cryodestruction

Cryosurgery was introduced in the 1970s by Ozenberger (1970).
This method consists in freezing the shell under local application anesthesia with a cryoprobe using nitrous oxide or liquid nitrogen as a cooling agent.
When the cryoprobe touches the mucous membrane, ice crystals form inside the cells, destroying the cell wall. Cryotherapy causes thrombosis of small vessels in the area of ​​application and local exsanguination. All these destructive processes lead to a decrease in the turbinates.
It was found that necrosis after freezing is different from that after caustic. It was assumed that necrotic tissue would be replaced by new respiratory epithelium.
Cryosurgery was gradually abandoned for a number of reasons.
It is difficult to predict the amount of tissue removed. Moreover, compared with other methods, long-term results are disappointing, as was confirmed by the studies of Passali et al. (1999).

Chemical coagulation - chemocaustics

The use of chemical coagulation of the shell surface in order to reduce their size also came into practice in the last decades of the 19th century.
Initially, a saturated solution of trichloroacetic acid (TCA) was used, which was applied to the mucous membrane (eg, von Stein, 1889); later, chromic acid melted to form a pearl was also used (Figure 3). As early as 1903, doubts arose about the merits of chemical coagulation. In most clinics, the results were described as positive, but microscopic examination revealed significant necrosis of the mucous membrane (Meyer, 1903). This author recommended that TCA be applied intensively, suggesting that the epithelium would heal better as new epithelium would outgrow necrotic tissue.
This technique is the worst one can imagine: while the shells are only slightly reduced, it causes massive destruction of the functional structures of the mucous membrane, cilia and glands.

Corticosteroid injection

In 1952, injections of long-acting corticosteroid solutions were introduced as a new technique for reducing hypertrophied turbinates (Semenov, 1952). Several authors have reported that corticosteroid injections are effective in treating nasal hyperreactivity, regardless of etiology (Semenov, 1952; Simmons, 1960, 1964; Baker and Strauss, 1963).
Corticosteroid injections are minimally invasive, but the subjective improvement in nasal breathing is short-lived. This procedure has only been successful in reducing turbinate edema for a period of 3 to 6 weeks (Mabry, 1979, 1981).
Later, most authors rejected injections into the shell because they can cause acute homolateral blindness (Baker, 1979; Byers, 1979; Evans et al., 1980; Mabry, 1982; Saunders, 1982; Rettinger and Christ, 1989).

Vidian nerve neuroectomy

In 1961, Golding-Wood took a fundamentally new approach to solving the problem. He proposed transection of parasympathetic nerve fibers in the Vidian canal to reduce the parasympathetic tone of the nasal mucosa. In this way, he hoped to reduce the manifestations of hypersecretion and nasal congestion. This technology was developed at a time when drug treatment for hypersecretion was still very limited. Subsequently, various approaches to the Vidiev Canal were developed. Initially, the transantral approach was used (Golding-Wood, 1973; Ogale et al., 1988), later supplemented by the endonasal method with ganglion coagulation (Portmann et al., 1982).
Vidian nerve neuroectomy has been widely used, but its effect has been limited (Krant et al., 1979; Krajina, 1989). Hypersecretion decreased, but not nasal congestion (Principato, 1979). For these reasons, in the early 1980s, this technology was abandoned.

According to leading ENT specialists, the main assessment of the effectiveness of operations on the inferior turbinate should be a decrease in complaints while maintaining function. And although there is no agreed opinion on the use of certain methods of surgical intervention, it follows from the information presented above that, apparently, electrocaustics, chemical caustics, turbinectomy (subtotal), cryosurgery, surface laser surgery should not be used, since these technologies too destructive.

Intraturbinal cavity reduction (intracancerous turbinoplasty) appears to be the method of choice.

Sources of
Rhinology, 38, 157-166, 2000
Myrthe K.S. Hot and Egbert H. Huzing
Department of Otorhinolaringology, University Medical Center Utreht, the Netherlands
Willatt D. The evidence for reducing inferior turbinates. Rhinology. 2009 Sep; 47 (3): 227-36.
Turbinate Reduction - A minimally invasive return to normal nasal breathing. [Electronic resource]. Resource access mode http://www.arthrocareent.com/procedures/view/6-turbinate-reduction
Davydova S.V., Fedorov A.G. Operative endoscopy, surgical energies: electrocoagulation, argon plasma coagulation, radio wave surgery, endocliping: Textbook. allowance. - M .: RUDN, 2008 .-- 146 p.
Pukhlik S.M., Alexandrov A.D. Interventions on the inferior turbinates in chronic rhinitis. Rhinology №3, 2008.

Postoperative nasal surgery memo

Operations on the nose

Septoplasty - correction of the nasal septum. In some cases, plastic plates supporting the septum are placed at the end of septoplasty, which are fixed with a suture and removed after a week.
Conchotomy - partial removal of the inferior turbinates. After the operation, open wounds remain on the side walls of the nose, this part is not sutured, possibly more bleeding.
FESS - expanding the natural passages in the sinuses and cleansing the sinuses.

Nose care
After the operation, nasal congestion appears, the release of blood secretions, and crusts form in the nose. A headache may appear, sometimes an increase in body temperature (usually not higher than 38 ° C).
To rinse the nose and facilitate breathing, it is advisable to use
sea ​​salt water (Humer),
emollient ointment (Nisita),
oil (Coldastop).

Nasal care products are available over the counter without a prescription. You should take care of your nose until the nose is clear of secretions and crusts (2-3 weeks).
To reduce pain and body temperature, paracetamol, solpadein (without a prescription) are allowed, do not cause bleeding. Aspirin and ibuprofen are prohibited from medications. They thin the blood and increase the risk of bleeding.

Blow out the nose carefully, not strongly, alternately one side, then the other.

If you are diagnosed with high blood pressure, keep it under control, continue to take your medications prescribed by your doctor.

Mode
After the operation, you have a risk of bleeding for 2 weeks, therefore:
refrain from hot drinks / food,
refrain from visiting the bathhouse, tanning, solarium, from restorative procedures,
careful with physical activity.

Drinking water should be cool.

Contact a doctor!
with severe bleeding,
at elevated temperatures (above 38 ° C),
with increased pain and nasal congestion.

Forum. Who did the vascular vasotomy of the nose!

Reduction of hypertrophy of the inferior turbinates by radio wave method

Laser turbinoplasty of the lower turbinates

Submucosal resection of the inferior turbinates with a microdebrider (microdebrider destruction)

Endoscopic turbinoplasty

Endoscopic turbinoplasty under local anesthesia

When the nose does not breathe due to vasomotor rhinitis or a number of other reasons, patients are often prescribed a vasotomy of the turbinates.

This operation is designed to improve blood flow and permanently solve the problem of impaired nasal breathing.

Today there are several methods of performing this kind of surgical intervention. All of them have their own characteristics, advantages and disadvantages, therefore, when choosing a specific method, you must first of all listen to the opinion of the surgeon, who will certainly take into account all the wishes of the patient.

Vasotomy of the nose: what is it? Indications for surgery

Vasotomy is a surgical method for the treatment of chronic diseases of the nose, involving the destruction of the vessels of the nasal concha in one way or another, thereby reducing their volume.

During the operation, doctors exfoliate the mucous membrane and eliminate the vascular (venous) bundles, which provoke a deterioration in the patency of the air stream.

The lower turbinates themselves are small bony protrusions located on the lateral surfaces of the nostrils.

They are covered with a mucous membrane with a pronounced submucous layer, which is responsible for humidifying and heating the air inhaled by a person.

But in a number of diseases, swelling and hypertrophy of the turbinate occurs due to increased blood filling of numerous vessels of the submucous layer.

This provokes a narrowing of the passages and a deterioration in the permeability of the air flow during inhalation, up to its complete impossibility.


It is in such situations, when long-term conservative therapy has not borne fruit, that submucosal vasotomy of the inferior turbinate is indicated. As a rule, it is performed when:

• vasomotor, including
• chronic rhinitis;
• endocrine pathologies that provoke hypertrophy of the turbinates.

For children, the procedure can also be prescribed if indicated. Depending on whether both halves of the nose are affected or just one, bilateral and unilateral vasotomy can be performed.

Contraindications to nasal concha vasotomy

For many patients, the only way to restore normal breathing is vasotomy, the operation has few contraindications, however, in their presence, it cannot be prescribed. This is about:

• any acute infectious diseases;
• purulent processes in the paranasal sinuses, ears and other parts of the ENT organs;
• exacerbation of chronic pathologies;
• blood diseases.

Source: website If a patient is diagnosed with chronic sinusitis, sinusitis can be performed before or simultaneously with vasotomy.

What tests are taken for a vasotomy? Preparing for surgery

Before the procedure, patients are required to confirm the need for an operation and identify possible concomitant pathologies. Therefore, patients need:

• take blood tests;
• (endoscopic examination of the nasal cavity);
• Ultrasound of the paranasal sinuses (echosinusoscopy);
• sometimes CT or MRI.

2 weeks before the appointed date and also stop taking anticoagulants (including Aspirin, Fenilin, etc.) if they have been prescribed by other specialists to eliminate or prevent certain disorders.

Types of vasotomy: how is the operation done?

There are several techniques for reducing the volume of the turbinates. Which one is best for the patient, the otolaryngologist decides based on the nature of the course of the existing disease, the individual characteristics of the patient, age, etc.


Each technique has its pros and cons, so it's impossible to say for sure which one is the best.

However

Recently, classical surgical interventions are becoming a thing of the past, giving way to modern minimally invasive manipulations.

Instrumental

Open surgery is a traditional technique for treating turbinate hypertrophy. Depending on the situation, the doctor may suggest treatment using one of the following techniques:

Submucous. The essence of the method consists in the separation of the mucous membrane and the destruction of the submucosal plexuses of the vessels with a scalpel.

Lateralization (lateropexy). This technique involves breaking and displacing the shell to the wall of the nostril and fixing it in a new position, which allows you to increase the diameter of the passage and make room for a stream of inhaled air.

Vasoconchotomy (conchoplasty)- resection of a part of the nasal concha and the mucous membrane covering it.

As a rule, a vasotomy of the nose with sedation is performed, that is, during the procedure, the patient is conscious, is able to communicate and follow the surgeon's commands, but does not feel pain and is inhibited due to the introduction of strong sedatives. Less commonly, the procedure is performed under local or general anesthesia.


After it, the patient remains in the hospital, the duration of his stay in it depends on the severity of the postoperative period and the presence of complications. In any case, the procedure takes no more than 5-15 minutes.

Do blood vessels recover over time after a vasotomy? Usually not, since scar tissue remains in their place, which is the prevention of recurrence.

Turbinoplasty

The method is used in severe cases and consists in removing part of the turbinate through a small incision, although the mucous membrane is preserved.

It is highly undesirable to completely remove these anatomical structures, since this can lead to the development of undesirable consequences, in particular, the inability to breathe through the nose, although there will no longer be objective reasons for such a violation.

Attention

Among all the methods of surgical intervention, it is turbinoplasty that is considered the most effective.

This operation on the turbinates gives the most pronounced and lasting effect, but since it is quite traumatic, complications often arise after it.

Shaver destruction or microdebrider conchotomy

The method is classified as a surgical one. Its use allows for both turbinoplasty or conchotomy and submucosal vasotomy.

Its main difference from the classical operation is the use of a special instrument - a shaver. It is a kind of electric knife: a rotating blade connected to an electric suction device, so that when it is applied, all cut tissue is immediately removed from the operating field.

Laser nasal concha vasotomy

This method is one of the most popular because it is notable for its low cost, low level of trauma and high efficiency. When removing venous plexuses with a laser, the light guide is inserted into the nasal concha, and the energy of the beam provokes evaporation of the tissue.


After the procedure, breathing usually recovers fairly quickly, and the risk of relapse is low. In this case, undesirable consequences are rarely observed.

Radio wave disintegration of the inferior turbinates

This is one of the most modern minimally invasive methods for eliminating pathologically altered tissues and neoplasms. It involves the introduction of a probe under the mucous membrane, which produces radio waves.

They force the cells to actively vibrate, which leads to an increase in temperature to high values, coagulation of blood vessels and normalization of the size of the turbinates. The method is often called radio wave destruction, conchotomy or reduction.

Coblation

Coblation vasotomy (cold plasma or molecular quantum reduction) involves the creation of a cold plasma field around the surgical instrument, which leads to the appearance of ions of a certain kind, provoking the rupture of bonds between molecules. It is one of the methods of radio wave surgery.

When using coblation, tissues are heated only to 40–70 ° C. This allows you to solve existing problems with minimal damage to the surrounding structures.

Ultrasonic disintegration

The destruction of the submucosal layer occurs due to the action of ultrasonic waves. They provoke adhesion of the walls of the affected vessels.

Usually, the procedure is prescribed for mild forms of hyperplasia, that is, when the inferior turbinate, or both, only slightly increase in volume. In other situations, there is a significant likelihood of a relapse of the disease.

Vacuum resection

This relatively new method is only being introduced into medical practice today. Therefore, it is too early to talk about its effectiveness and safety.

Its essence consists in aspiration of cells of the submucous layer with a special instrument-pump by creating negative pressure.

In general, vacuum resection is a promising direction in otolaryngology and, possibly, in the future it will be no less popular than radio wave or laser disintegration.

Cryodestruction of the turbinates

The essence of cryodestruction is the treatment of the mucous membrane with a cryoprobe at an extremely low temperature. As a result, large ice crystals form in the cells, which destroy the cell membranes.

The procedure causes thrombosis of the capillaries at the site of exposure, as a result of which they are exsanguinated and the swelling disappears.

Electrocautery

This method involves the destruction of vascular bundles with direct electric current. Cauterization occurs by touching the affected areas with a hot electrode.

The procedure causes the tissues to scar, which leads to compression of the venous plexuses and, accordingly, to a decrease in the volume of the turbinates, while instant coagulation (sealing) of the vessels occurs, therefore the manipulation is not accompanied by bleeding. Sometimes it is also called electrocaustics or galvanocaustics.

Today, electrocautery is used less and less, since it is considered morally obsolete. There are many other methods that give a more pronounced effect with less damage to healthy tissue.

Septoplasty and Vasotomy

Often, both procedures are combined, since congenital or acquired as a result of trauma (more often in men) deformities of the septum, can also contribute to respiratory failure.

Septoplasty means that it is performed by removing a bulging part of the cartilage or bone crest.


This is an endoscopic operation, therefore, its implementation is associated with minimal damage to anatomical structures, which leads to a short rehabilitation period. Both procedures are indicated for patients who have

Price

The cost of a vasotomy depends on the type of technique used, the rating of the medical institution, its territorial location and the doctor's experience.

In otolaryngology departments, classical surgical intervention can be performed absolutely free of charge, while in private clinics in Moscow and St. Petersburg, elimination of hypertrophy with a laser or Surgitron apparatus (radio wave disintegration) can cost from 3,000 to 30,000 rubles.

Rehabilitation after septoplasty and vasotomy

Recovery is usually fast enough. The duration of the rehabilitation period depends on the method of the operation, while often patients receive sick leave for the entire recovery period.

After classical operations, the nose is tamponed several times. Finally, the tampons are removed only after the formation of dense crusts.


If the surgical intervention was as gentle as possible, that is, techniques such as laser, radio wave, ultrasonic disintegration, etc. were used, the patient can leave the clinic. already half an hour after the end of the manipulation. In any case, in the postoperative period, it is prohibited:

• visit the bathhouse, sauna, swimming pools, gym;
• lift heavy objects;
• run;
• drinking alcohol.

Patients need to carefully care for their nose after any type of vasotomy and follow the advice given by the ENT exactly.

Usually, experts recommend washing with saline solutions several times a day (Aquamaris, Physiomer, Marimer, No-salt, Dolphin, Aqualor, Salin, saline) and treating mucous membranes with neutral oil, for example, vaseline, peach, sea buckthorn.

After surgery, broad-spectrum antibiotics are often prescribed to prevent infection. If necessary, patients can take pain relievers to relieve pain.

Possible complications after surgery

After the procedure, swelling, thick snot and crusts are almost always observed. When using a laser, radio knife, or similar minimally invasive techniques, the condition returns to normal in about 3-5 days, but after surgery - only after 1-1.5 months.

This explains the fact why after the vasotomy the nose does not breathe again or the sense of smell has disappeared. For the final restoration of the normal functioning of the nose it takes time for tissue healing, elimination of puffiness, etc., although sometimes patients in such cases need a second operation ..
The most likely complication may be the addition of an infection, this can be suspected by an increase in body temperature, as well as if the runny nose has intensified, in spite of everything. Also sometimes mucosal atrophy is observed, which is accompanied by dryness and discomfort.