Abstract
Hypothesis
The study aimed to assess the efficacy of bipolar scissor in the treatment for patients with inferior turbinate hypertrophy.
Materials and Methods
A prospective cohort clinical study was conducted on 10 adult patients who were chosen with a diagnosis of turbinate hypertrophy.
Results
Ninety percent of our cases were satisfied with the procedure, there were significant drops in the sensation of nasal obstruction, the average duration of the procedure was 20 minutes for both sides, and only a single case was complicated with a small burn on the vestibule.
Discussion
Bipolar scissor could be applied safely in turbinate surgery to perform a rapid effective turbinectomy without packing or overnight hospital stay.
1
Introduction
Chronic nasal obstruction is one of the most common human problems and a very frequent symptom in the ear, nose, and throat field. Hypertrophy of the inferior turbinate is the most frequent cause and may be related to allergy, pseudoallergy, nonallergic rhinitis with eosinophilia syndrome, and iatrogenic rhinopathy . When medical treatment fails, patients often benefit from surgical reduction of the inferior turbinate.
Various techniques have been described including turbinectomy, submucosal turbinectomy, microdebrider submucosal resection, cryotherapy, submucous electrosurgery, and laser turbinectomy. Each technique has some inherent weakness including lack of efficacy and early and late complications (bleeding, crusting, mucosal tears, atrophic rhinitis, and significant cost and recovery times) . The ideal surgical technique has yet to be demonstrated.
Bipolar electrosurgical scissor is a new instrument that was originally designed for open surgery using a dual function that cuts and coagulates at the same time . Bipolar scissor appears to combine the best of cold scissor dissection and electrosurgical techniques, allowing rapid removal with minimal bleeding and desirable tissue effects . Bipolar scissor has been studied extensively in tonsillectomy , but to our knowledge, no author tried to study the efficacy of this relatively new instrument in turbinate surgery.
The purpose of this study is to prospectively assess the efficacy of bipolar scissor in the treatment for patients with inferior turbinate hypertrophy.
2
Materials and methods
2.1
Study design
A prospective cohort clinical study was conducted on 10 adult patients who were chosen with a diagnosis of turbinate hypertrophy. All of these 10 patients had symptoms and signs of nasal obstruction and stuffiness related to enlarged turbinates and were treated between May 2008 and September 2009. Patients gave their written informed consents before being included in the study, which was approved by the local ethics committee. All procedures were performed by one author (A.A.).
Patients with previous turbinate surgery, septal deformities, nasal polyps or tumor, nasal radiotherapy, or recurrent sinusitis were excluded. Coagulation disorders, cardiac pacemaker, and uncontrolled hypertension were additional exclusion criteria.
Among our patients, there were 8 men and 2 women, the mean age was 32.2 years (±5.4 years).
2.2
Surgical procedure
All surgical procedures were performed by the same surgeon (A.A.). The surgical interventions were carried out with the patient under general hypotensive anesthesia.
After adequate anesthesia, the inferior turbinate was infiltrated with combined 2% xylocaine and 1:100 000 epinephrine, patients were postured with semi–sitting position and draped for operation. All surgical procedures were performed under the direct vision of straight, 4-mm diameter, 0° endoscope (Karl Storz, Tuttlingen, Germany). The technique involves fracture of the turbinate bone toward the midline and cutting along its lateral attachment using PowerStar Bipolar scissor (Ethicon Ltd, Edinburgh, United Kingdom) ( Fig. 1 ). The bipolar scissor is a modified 7-in Metzenbaum scissor with 2 blades that are insulated from each other by applying a ceramic coat to the inner surface of one blade and clear surface hardening to the other blade. The handles and part of the outer surface of the blades are covered with plastic. Antibiotic therapy with amoxicillin-clavunate and analgesia with acetaminophen were given for 5 days postoperatively. Patients visited our office twice a week for 4 weeks after operation where nasal clearance was done, and patients were asked to use saline irrigation twice daily for 3 weeks after the procedure.
2.3
Evaluations
Subjective symptom (severity of nasal obstruction) was measured by a standard 10-cm visual analog scale (VAS).
A score of zero represented no obstruction and no episodes of nasal obstruction, and a score of 10 indicated complete nasal obstruction and constant, unremitting nasal obstruction. Questionnaires were performed before the procedure and 3 months after operation, respectively. The subtract score between postoperative and preoperative symptom scores was calculated, and we thought that subjective improvement of symptom is greater when the positive value is larger. The patient’s satisfaction about the postoperative symptom relief was also asked. We compared the preoperative VAS score with those of 3 months after operation and evaluated the degree of improvement. We also reported the pure operative time, duration of crust formation, and postoperative bleeding.
Duration of crust formation was estimated as the period from the operation to the point of disappearance or detachment of major crust from the turbinate with the healed underlying mucosal surface. Postoperative bleeding was defined as a condition that required the temporary nasal packing with Vaseline gauze or Merocel (XOMED Surgical Products, Jacksonville, FL).
2.4
Statistics
Postoperative improvement in our patient group was evaluated with Wilcoxon signed rank test. P values less than .05 were considered significant.
2
Materials and methods
2.1
Study design
A prospective cohort clinical study was conducted on 10 adult patients who were chosen with a diagnosis of turbinate hypertrophy. All of these 10 patients had symptoms and signs of nasal obstruction and stuffiness related to enlarged turbinates and were treated between May 2008 and September 2009. Patients gave their written informed consents before being included in the study, which was approved by the local ethics committee. All procedures were performed by one author (A.A.).
Patients with previous turbinate surgery, septal deformities, nasal polyps or tumor, nasal radiotherapy, or recurrent sinusitis were excluded. Coagulation disorders, cardiac pacemaker, and uncontrolled hypertension were additional exclusion criteria.
Among our patients, there were 8 men and 2 women, the mean age was 32.2 years (±5.4 years).
2.2
Surgical procedure
All surgical procedures were performed by the same surgeon (A.A.). The surgical interventions were carried out with the patient under general hypotensive anesthesia.
After adequate anesthesia, the inferior turbinate was infiltrated with combined 2% xylocaine and 1:100 000 epinephrine, patients were postured with semi–sitting position and draped for operation. All surgical procedures were performed under the direct vision of straight, 4-mm diameter, 0° endoscope (Karl Storz, Tuttlingen, Germany). The technique involves fracture of the turbinate bone toward the midline and cutting along its lateral attachment using PowerStar Bipolar scissor (Ethicon Ltd, Edinburgh, United Kingdom) ( Fig. 1 ). The bipolar scissor is a modified 7-in Metzenbaum scissor with 2 blades that are insulated from each other by applying a ceramic coat to the inner surface of one blade and clear surface hardening to the other blade. The handles and part of the outer surface of the blades are covered with plastic. Antibiotic therapy with amoxicillin-clavunate and analgesia with acetaminophen were given for 5 days postoperatively. Patients visited our office twice a week for 4 weeks after operation where nasal clearance was done, and patients were asked to use saline irrigation twice daily for 3 weeks after the procedure.
