Nasal Mucotomy

What are turbinates?

Nasal turbinates (or conchae) are long, narrow, curled shelves of bone which protrude into the breathing passage of the nose. The turbinates divide the nasal airway into 4 groove-like passages, and are responsible for forcing inhaled air to flow in a steady, regular pattern around the largest possible surface area of nasal mucosa, which – as a ciliated mucous membrane with shallow blood supply – cleans and warms the inhaled air in preparation for the lungs.

The inferior turbinates are the largest, and can be as long as the index finger in humans. They are responsible for the majority of airflow direction, humidification, heating, and filtering of air inhaled through the nose.

Sometimes the inferior turbinates can become enlarged – a condition called inferior turbinate hypertrophy. The most common causes of inferior turbinate enlargement are the long-term use of “conventional” nose drops and nasal sprays, allergic rhinitis, chronic non-allergic rhinitis, side effects of certain medications, nasal congestion, acid reflux and pregnancy.

When is nasal mucotomy of the inferior turbinates recommended?

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Nasal mucotomy of the inferior turbinates is necessary when the turbinates become enlarged and cause nasal obstruction which is a fairly common problem. Patients with nasal obstruction have trouble breathing through the nose. As a result, they may breathe through their mouth, leading to a sensation of dry mouth. The symptoms are usually worse at night when the patient is lying flat, causing often preventing restful sleep.

How is the surgery performed?

Nasal mucotomy of the inferior turbinates is a simple procedure carried out under local anesthesia on patients whose symptoms previously did not respond to conservative treatment. The most common technique is to only reduce the thickness of the soft tissue lining from the inside without actually removing the mucosa. It is a simple and painless outpatient procedure with no bleeding. In some cases, the position of the turbinates is such that the middle turbinates block sinus drainage. In these cases it might be necessary to modify the turbinate bone.

What are the risks and benefits of the surgery?

The main benefit of the operation is the disappearance of troublesome symptoms. Patients who undergo this type of surgery may become less susceptible to infections after the intervention.
As with any surgery, there are some risks associated with nasal mucotomy of the inferior turbinates.

Although the chance of a complication occurring is very small, it is important that you understand the potential complications such as dryness of the nasal and pharyngeal mucosa, scarring or secondary bleeding. Feel free to ask your surgeon about any concerns you may have.

Am I a good candidate for this type of surgery?

If alternative treatments have not been successful in improving your symptoms, surgery may be helpful. Your ENT (ear, nose and throat) surgeon will recommend nasal mucutomy if it seems necessary based on your medical history and symptoms.

How to prepare for the surgery?

Be aware of any restrictions to adhere to prior to your appointment. Your ENT surgeon will provide you with detailed information regarding the preparation for your physical exam and diagnostic, blood and allergic tests.

Surgeons recommend that patients avoid any medications that may lead to bleeding, such as NSAIDs (e.g. aspirin, ibuprofen). If you have any questions about which medications you may and may not take, feel free ask your surgeon.

What to expect after mucotomy?

You may experience some pain, fatigue, nasal congestion and/or discharge after your surgery. The pain associated with this type of procedure is generally mild and well-managed with oral pain killers. The stuffiness usually results from swelling, and starts to improve significantly after about a week. You may have some mucous or blood-stained nasal dicharge after surgery. This is a normal part of the healing process.

Why is post-operative follow-up important?

The first follow-up exam will take place a week after surgery. At this appointment you will receive a nasal cleaning treatment to prevent infections and the development of adhesions. Depending on the type of procedure, complete healing may take three to ten weeks.

Your doctor may recommend that you use nasal irrigationor saline sprays after your surgery. Please check with your surgeon about any post-operative care you will need to perform to allow your nose to heal properly.