What are Nasal Turbinate’s?
Respiration is a process of breathing in oxygen and exhaling carbon dioxide. The air inhaled through nose, travels through the upper respiratory passage, trachea and enters lungs where it gets purified. Oxygen rich air circulates in all parts of the body which is used by cells to break down sugar that release energy for normal physiological functions within the body. As every single cell requires oxygen, respiratory system formed of nose, pharynx, larynx, trachea, bronchi and lungs should be guarded from environmental changes, allergens and pollutants that harm the organ system.
Nose or the nasal passage is the foremost upper part of respiratory system. It protrudes out from the middle part of face, giving sense of smell and a definite facial contour. The most important function of nose is entry of air into the upper respiratory passage. It filters, cleans air to remove particles, dust and allergens to enter into deep within respiratory tract and lungs. It warms the air so it can reach the trachea easily. Nose is formed of bones, nasal cavities and nerve cells.
The hard bridge on the nose and the septum are made up of bones and cartilage. Hair and cilia inside the nose trap dirt, dust particles which reach nostrils and can be easily removed during sneezing so they do not reach throat, trachea and lungs. The lateral walls of nose are formed of cartilage, covered in skin which extend to form nostrils. Nasal cavities are hollow spaces lined by mucus membrane with openings called as nostrils through which air enters into the upper respiratory passage. There are four pairs of sinuses or air filled pockets around the nose that produce mucus to keep the nose moist.
NASAL TURBINATES or conchae are located along sides of both nasal cavities. There are three pairs of turbinate’s fold inside the nose. The function of nasal turbinate’s is to warm, humidify and filter air after the air enters nose during breathing. It also plays an important role in nasal drainage. Nasal turbinate’s are shell shaped networks of bones, vessels and tissues inside the nasal passage. The three pairs of turbinate’s are located on the superior, inferior and middle within the nasal air way passage. Occasionally a fourth turbinate is also present, located higher to the superior turbinate. It is called the supreme turbinate. A space is present in between each turbinate’s called the meatus which forms a natural passageway which allow airflow through the nose.
The inferior meatus is a space between floor of nasal cavity and inferior turbinate. It has the largest air space where the nasolacrimal duct or the tear duct that initiates from external eye empties secretions of eyes into the inferior meatus. Nasal valve is a narrow opening formed of fusion of head of nasal wall and inferior meatus. This aperture is a site of obstruction during nasal abnormalities or disorders like deviated nasal septum.
The middle meatus is a nasal passageway that lies between the inferior meatus where three paranasal sinuses drain secretions.
The superior meatus lies between middle meatus. Paranasal sinus drain secretions here. This meatus helps to modify vocal features. Mucus membranes along with upper part of nasal septum divide into right and left nostril, lined with nerve endings that direct to sense of smell. Hence, any disorders of turbinates result in loss of sense of smell.
What is the Physiological Function of Nasal Turbinates?
The nasal passageway go through a cycle of constricting one turbinate while the other turbinate swell. This natural phenomenon takes place every one to seven hours. The shrinkage of turbinate makes the nasal passage narrow, but enlarges path through the other two turbinates to improve air flow. This prevents nasal congestion as the nasal passage is not obstructed. The process if constriction by one turbinate and enlargement of the other turbinates improve air flow and maintain moisture within the nasal passage.
What are Common Nasal Turbinate Disorders?
Upper respiratory tract begins with nose, nasal airway passage and is under constant contact with environmental changes. Nasal cavity is the most susceptible to acquire contagious diseases that are caused from droplet infection or acute weather changes. Statistical survey has proved that since decades people all across the world get infected with diseases of upper respiratory tract.
Corona virus disease is a menace, a pernicious, detrimental, lethal infection of the respiratory tract that harmed people globally. The toxic virus in the environment spreads when people breathe in contaminated air borne particles or when they get infected by coming in direct contact with an infected person through droplet infection. The risk of getting infected and its spread has reduced to certain extent after mass vaccination. The atrocities of the vicious, aggressive environment continues to torment world through birth of different novel strains or variants of virus mimicking a diseased picture of common respiratory diseases. Treatment of infections, its prevention, awareness programs and reasonable guidance to every citizen are tutored to overcome future environmental hazards, risks that endanger healthy life.
Immunity plays a crucial role in restoring health. People with a strong immunity are resistant to infections caused by environmental changes. Lack of hygiene, knowledge about harmful pollutants or microorganisms that cause infections, crowded places and poor quality life style in low socio-economic over populated areas cause several infections diseases.
Disorders of nasal turbinate’s give rise to congestion. Common cold is a disorder of nasal turbinate’s. Allergies, sleep apnea, nasal valve prolapse, auditory tube dysfunction, concha bullnose and channel atresia are nasal turbinate disorders. These conditions cause sinus infection, difficult sleep, obstruction during breathing, fever, cough and cold. As these symptoms cause immense discomfort, treatment of the above diseased condition by a medical professional should be seeked for by patients to get prompt relief.
The treating physician records signs and symptoms of patient. Blood tests, X ray, CT scan, allergy testing are few diagnostic tests advised by the doctor. Once it is confirmed, doctor prescribes medication. If required, turbinectomy surgery is done to remove enlarged turbinate’s to relieve blocked nose and reduce snoring.
What is Turbinectomy Surgery?
Turbinectomy is a surgery done to reduce size of nasal turbinate’s. The procedure is either partial turbinectomy or combined bilateral inferior and middle turbinectomy. When nasal turbinate’s become swollen or enlarged because of disorders of disorders of nasal airway passage, it causes nose blockage and breathing difficulties. This condition is called turbinate hypertrophy. Turbinectomy is the choice of treatment when medical therapy fails in treating disorders of nasal turbinate’s.
Recurrent allergies, respiratory tract infections from acute weather changes, stress, certain types of medication, hormonal changes and trauma cause enlarged, swollen or displaced turbinate’s. Turbinectomy is performed by an ENT surgeon to relieve patients from symptoms caused by nasal turbinate disorders. The surgery is done under local or general anesthesia. The surgery is performed inside the nasal cavity. It is often a minimal invasive surgery.
Patient is advised to follow necessary guidelines prior the surgery.
CAUTERISATION- COBLATION AND RADIOFREQUENCY TURBINATE REDUCTION—
The surgery is performed through both nostrils in an operating room. An endoscope, a thin flexible tube with a light and camera at one end is used during the surgery. The turbinate’s are shrunken without removing any bone or tissues. A specialized needle like device is inserted into the turbinate. Then the turbinate is heated by means of a needle using a heat source or an energy wave. This process forms a scar like tissue which shrinks the turbinate’s. This process takes upto twelve to twenty minutes, done under local anesthesia. Patient may experience pain and localized swelling for few days, later it gets resolved.
The use of radiofrequency ablation is a safe alternative procedure. It is done using lidocaine, under local anesthesia. Patient does not have any post operative pain or bleeding with minimum risk to post operative complications.
SURGICAL TURBINATE REMOVAL- It is an invasive procedure performed inside nose, without any external incisions. General anesthesia is used before the procedure is performed. This surgery is often combined with a deviated nasal septum surgery or a sinus surgery. It is a surgical reduction process where the surgeon cuts into two turbinate’s to excise the bone lying underneath thereby reducing size of turbinate’s. Some of the tissue surrounding the turbinate can later be excised.
In total turbinectomy, scissors are used to detach the turbinate directly at the base of the lateral nasal wall. This technique has minimal side effects. In case of partial turbinectomy, the mucosa and bones are resected in the front third of the turbinate. The use of endoscope during the procedure, directs surgeon to remove tissue of the anterior turbinate area, thereby preserving the head of inferior turbinate. After the removal of certain part of tissue, the lateral mucosal plate is placed over the bone which is fixed with fibrin. The turbinates’ are pushed outwards after excision of tissue, its reduction, hence increasing the space between the turbinate’s and septum to increase air flow by removing air way obstruction.
In subtotal inferior turbinectomy, the inferior turbinate is clamped using hemostat. This is done at the anterior one third and two third of inferior turbinate. Incision is made along the turbinate, nasal mucosa and reduction or resection of the tissues near the affected turbinate along with excision of nasal mucosa is done. Angled scissors are used to cut the hypertrophied tissues and bone surrounding the affected turbinate. Insulation through cauterization is the next important step that causes suction and develops hemostasis. Then the final step of closing the incision and covering nose with nasal bandage completes the surgical treatment procedure.
Laser surgical procedures are performed under local anasthesia. Lasers produce beam of coherent light that gets easily absorbed by the tissues. A definate frequency wavelength of light energy is administered sufficient enough for tissue absorption. The mode of applying the laser energy can be made flexible with minimum tissue excision, without any thermal damage to surrounding healthy tissues within the nasal passage. The use of computerized laser with advance technology will revolutionize surgeries that will protect nearby tissues within the proximity of the excided tissue, hence giving promising results.
After the surgery, patients experience swelling, pain with blood stained nasal discharge. The nose is covered with cotton, dressing is done around it using antiseptic for upto forty eight hours to heal the external cuts. Painkillers, antibiotics to prevent any infection, nasal and oral decongestants are prescribed to the patient before discharge from hospital or clinic. Patients can resume work post one week of surgery. Recovery from surgical treatment procedure takes within a month.
What are the Avantages of Turbinectomy Surgery?
Patients who had chronic nasal obstruction secondary to turbinate hypertrophy, respond well after surgical turbinectomy treatment procedure. Middle conchae turbinectomy treats migraine. It has also known to treat sinus headaches. Patients gets relief from nasal airway passage blockages, recurrent congestion, persistent nasal obstruction and complaints related to allergic rhinitis.
Turbinectomy surgery is useful to treat children having difficulty while breathing and sleeping due to blocked nasal passage and those who suffer from recurrent nosebleeds with loss of sense of smell. Turbinectomy surgery in children take place for upto twenty minutes under general anesthesia. An ENT surgeon uses specialized telescopes to understand the nasal airway passage obstruction. Specialized medical instruments are used during the surgery, specifically designed and meant to treat paediatric nasal turbinate disorders.
Turbinectomy is a surgical procedure to restore physiological functions within the nasal cavity from any pathological or anatomical derangement. This surgical technique is widely opted by surgeons world wide as very less tissue reduction takes place with preservation of mucosal lining surrounding nasal cavity.
A normal nasal respiratory function involves air flow without any obstruction, through nasal turbinates particularly the inferior nasal turbinate, it is essential to prevent its hypertrophy that may deteriorate normal physiological functions. Patients should follow post operative precautionary guidelines advised by the doctor. Allergens should be identified so prompt medical attention can be given to avoid surgical intervention. People should be made conscious of environmental pollutants, microorganisms that disrupt the airway mucosal passage, nasal turbinates and thus should be educated to take relavent steps towards health care.
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