Turbinate reduction surgery is a very common procedure that is done as part of reconstructive nose surgery performed by facial plastic surgeons and otolaryngologists (ENT surgeons). To understand what turbinate reduction surgery really is, you first have to understand exactly what the inferior turbinate is and what we are trying to accomplish with the surgery.
What Is The Inferior Turbinate?
The inferior turbinate is an elongated, almost tubular structure inside of the nose that is intended to humidify air as it passes through the nasal passageway. In addition to humidification, the inferior turbinate also helps with heating and filtering the air breathed in through the nose. Therefore, it is considered a necessary anatomical component that is vital to having optimal nasal breathing. Without an inferior turbinate, you would have less humidification, heating and filtering of the air you take in through the nose and, therefore, less than ideal physiological breathing.
The inferior turbinate is approximately the size of an adult index finger. It is positioned against the side of the nasal passageway and runs parallel to the nasal septum, which is the wall that separates the left and right nasal passageway. As is shown in the adjacent diagram, there is an inferior turbinate on each side of the nose, although they are not necessarily the same size. There are actually three paired sets of turbinates in the nose – the superior (uppermost), middle (in between), and inferior (lowermost) – as is also depicted in the diagram. But of the three pairs, the inferior turbinates are typically more involved in routine nasal breathing and more often evaluated in conjunction with the septum.
The inferior turbinate is composed of an inner floating bone (white) wrapped on the outside by a mucosal lining (pink). When assessing the inferior turbinate, both the bone and lining should be considered since each contributes to the overall size, shape and function.
What Is Turbinate Hypertrophy?
Inferior turbinate hypertrophy simply means that the turbinate has increased in size. Turbinate hypertrophy can occur as a result of number of medical conditions. These include chronic nasal allergies and vasomotor rhinitis (which is abnormal nerve innervation that results in enlargement of the inferior turbinate). In addition, the inferior turbinate hypertrophy can result from deviation of the septum. For instance, if the nasal septum is deviated to the right side of the nose, the left inferior turbinate is going to ‘see’ more airflow since the opposite side is relatively obstructed. Since turbinates naturally respond to airflow by enlarging, they will swell more on the side that does not have the septal deviation.
So what does this mean if the inferior turbinate enlarges and swells? This usually translates into some form of nasal congestion, or difficulty breathing through the nose. This can occur on one side or the other. In some instances this may be bilateral and in others it may alternate between the left and right sides. Whenever this type of turbinate enlargement or swelling occurs, the patient will note some degree of nasal obstruction because the nasal airway becomes tighter or even closed off in some cases. The adjacent diagram shows this visually where the turbinates enlarge and now occupy more space in the nose. You can imagine what might occur if there is a septal deviation on top of all this. If the septum is deviated and already causing some degree of nasal obstruction, the turbinate hypertrophy will just compound this problem.
Turbinate Reduction Surgery
In many cases, turbinate hypertrophy can be successfully treated with topical medications, such as nasal steroid and antihistamine sprays. In other cases oral antihistamines can be used to control the symptoms of turbinate hypertrophy. But there is a significant number of patients who simply don’t respond favorably to the medications to reduce the size and activity of the turbinates. In these patients who have what is termed ‘refractory symptoms’ of turbinate hypertrophy, surgery may help provide them more long-term relief.
The surgery to reduce the size of the turbinate is referred to as a ‘turbinoplasty’ by some surgeons. Others refer to this as ‘submucous resection’ of the turbinate. There are a wide variety of surgical procedures intended to treat turbinate hypertrophy. All of them are performed through the nostrils so there is no external incisions or scarring. Some involve use of a cautery type of device to heat the inside of the turbinate, thereby shrinking it down in size. Others, like Coblation, involve a technology called radiofrequency ablation, which also reduces the size of the turbinate from inside out. These methods for inferior turbinate reduction primarily target the mucosal component and do very little to the bone. In some patients, this is adequate to reduce the size of the turbinate and can result in significant improvement in their breathing. The following diagrams visually demonstrate this on the side view of the inside of the nose. On the left you can see how the inferior turbinate is enlarged along its entire length. The middle diagram shows a bipolar cautery device being inserted into the inferior turbinate just underneath the outer mucosal lining as part of the reduction surgery. On the right is the inferior turbinate now reduced in size. Compare this with the turbinate in the first diagram.
In other patients, however, the bony component of the turbinate has to be addressed as well. In these cases, the inferior turbinate can be approached by making a small incision along the front border to expose the underlying bone. The bone can then be partially resected and/or moved out to the side to help improve the nasal breathing. With time, this type of inferior turbinate reduction surgery will also see the mucosal lining shrink wrap down as the tissues scar inward progressively.
In some patients, a combination of these techniques may be utilized to obtain the most optimal surgical result.
So what is the best technique for inferior turbinate reduction surgery? The answer is – it is not known at this time. In the hands of a well-trained nose specialist, most patients with inferior turbinate hypertrophy are going to see a notable improvement in nasal congestion in a majority of cases. Your best bet is to consult with a board certified facial plastic surgeon or otolaryngologist-head and neck surgeon to determine what technique would suit your specific problem.
Does Insurance Cover Turbinate Surgery?
The answer is – yes. In most cases where the diagnosis of inferior turbinate enlargement or hypertrophy has been made and the patient has not responded ideally to use of topical nasal medications, health insurance should cover the surgery. In a good number of patients, inferior turbinate reduction surgery is commonly combined with septoplasty, or septal reconstruction, for a deviated septum. As always, you need to check with your insurance carrier to confirm actual coverage for these individual procedures.