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neurological sequel such as grater palatine nerveINTRODUCTIONdehiscence, occlomoter and trigeminal nerve

Nasal obstruction is one of the common 10,11,12pa lsy . However cases no t re sponding to

presenting symptoms to Ear, Nose, and Throat outconservat ive measures wi l l need surgica l1-3

patient department . This may be either due tointervention. Neres first described sub mucosal

deviated nasal septum or turbinate Hypertrophydiathermy in 1907 and Horn in 1908. In 1930owing to vasomotor or perennial allergic rhinitis.Beck reported the use of unipolar cautery and in

Most cases of hypertrophic turbinate are treated1931 Hurd used bipolar ablation for hypertrophied

conservatively with anti histamine therapy, local 13inferior turbinate .

decongestant or allergy desensitization and4,5

steroid . Inferior turbinectomy has been described Woodhead described the changes caused toto relieve chronic nasal obstruction due to inferior turbinate by sub mucosal diathermy thathypertrophied inferior turbinate but the procedure induces sub mucosal fibrosis and thus reducing

14, 15have several complications like post operative size of the turbinate . It can be done under local6 7 , 8

hemor rhage , d ryness , c rus ti ng , excessive or general anesthesia. Care should be taken to9

secretion, foul odor, adhesion , epiphora and even avoid damage to nasal alae, columella, and nasalseptum. The aim of study is to compare the resultsof sub mucosal diathermy with partial inferiorturbinate resection in respect of safety and

efficacy.

METHODOLOGY

A prospective comparative study was doneat the department of E.N.T. H. M.C and Mardan

stMedical Complex from 1 July 2008 to 30 June2010 to evaluate the effects of Submucusaldiathermy with partial inferior turbinectomy in

patients with nasal obstruction. A total of fiftypatients of all ages and both sexes entered the

ORIGINAL ARTICLE

91PMI 2012 Vol. 26 No. 01 : 91 952012 Vol. 26 No. 01 : 91 - 95

ABSTRACTObjective: To compare the results in respect of safety and efficacy of Submucousal diathermy with partialinferior turbinectomy in terms of bleeding, pain, crusting and healing.

Methodology: A prospective comparative study was done at the department of ENT, HMC and MardanMedical Complex from 01 July 2008 to 31 June 2010. Fifty patients with inferior turbinate hypertrophywere selected by simple convience method and divided into two groups. Group A was subjected to

submucosal diathermy and group B to partial inferior turbinectomy. Patients were assessed with regard tonasal patency, pain, bleeding and crusting. Follow up was done at day 01, day07 and one Month.

Results: Out of fifty patients, 28 were females and 22 males. They were in the age range of 20 60 years.At day one assessment 22 patients with SMD had no bleeding while 10 patients with PIT had moderatebleeding (P=0.00). None of the SMD patients had severe pain while 8 patients with PIT had severe pain(P=0.002). At day seven 12 patients of SMD had moderate crusting as compared to 21 patients of PIT(P=0.008). At the end of one month 23 of SMD patients had good healing while only 13 PIT patients were

satisfied with healing(P=0.002).

Conclusion: We found Submucousal diathermy a safe and better procedure in respect of bleeding, pain,crusting and healing than partial inferior turbinectomy.

Key Words: Sub mucosal diathermy, partial inferior turbinectomy, Inferior turbinate.

This article may be cited as: Imad, Javed, Sanaullah.Turbinectomy: A Fifty Case Study. J Postgrad Med Inst 2012; 26(1): 91-5.

Comparison of Submucosal Diathermy with Partial Inferior

COMPARISON OF SUBMUCOSAL DIATHERMY WITH PARTIAL

INFERIOR TURBINECTOMY: A FIFTY CASE STUDY

1-3

Dr. Imad,Department of ENT,Bacha Khan Medical College, Mardan -PakistanE-mail: [email protected]

Date Received: April 29, 2011Date Revised: October 12, 2011Date Accepted: November 5, 2011

Department of ENT, Lady Reading Hospital,Peshawar - Pakistan

Address for Correspondence:

1 2 3Imad , Javed , Sanaullah

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in the l i t e ra ture wi th use of submucosalDISCUSSION8

microdebrider .Chronic nasal obstruction caused by

hypertrophied inferior turbinate is treated in a Anterior nasal bleeding is the major1, 2

variety of ways problem with turbinectomy. Maskel et al reported

significant bleeding in his study of lasserSurgical reduction of the turbinate can be9

3-5 turbinectomy . Nausheen reported partial inferiorperformed by several different techniques . Oneturbinectomy as the treatment option for interiormethod is lateral out fracturing of the inferior

7turbinate hypertrophy . However the procedure isturbinate at its attachment. Goode argued that the

7associated with more bleeding . Antonio found thatturbinate returns to its original position and the

6 , 7 sixty percent of his patients complained of mildb e n e f i t s a r e t e m p o r a r y . H e g a z y u s e d15

bleeding . Qazi reported 6% of patient withmicrodebrider for the turbinate size reduction butturbinectomy who needed anterior nasal packingresults are not as satisfactory, though short

3operative time and less bleeding has been reported for severe hemorrhage .

.

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COMPARISON OF SUBMUCOSAL DIATHERMY WITH PARTIAL INFERIOR TURBINECTOMY: A FIFTY CASE STUDY

93012 Vol. 26 No. 01 : 91 952012 Vol. 26 No. 01 : 91 - 95

Post-op day-7 assessment

Table 3: Crusting

Method

TotalSMD PIT

Crusting None 13

52.0%

4

16.0%

17

34.0%

Moderate 1248.0%

2184.0%

3366.0%

Total 25

100.0%

25

100.0%

50

100.0%

p-value=0.008 (Fisher exact test)

Post-op one month assessment.

Table 4: Nasal Permeability


MethodTotal

SMD PIT

NasalPermeability

Moderate 1768.0%

1456.0%

3162.0%

Good8

32.0%

11

44.0%

19

38.0%

25100.0%

25100.0%

50

100.0%

Total

Table 2: Pain

Method

SMD PIT

PainMild 14 (56%) 5 (20%)

Moderate 11 (44%) 12 (48%)Sever -- 8 (32%)


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M. Tahir et al, studied total and partial Grant Support, Financial Disclosureinferior turbinectomy and found 97% improvement and Conflict of Interestin patients with total inferior turbinectomy.Bleeding was the major problem which required

14anterior nasal packing for 48 hours . This did not

REFERENCEShappen in our patients of SMD. In our study 10cases (40%) of partial inferior turbecnictomy hasmoderate bleeding, while only 3 cases of

submucosal diathermy had mild bleeding.

Less operative time and pain has also beenreported with laser by Maskel et al, though therelief achieved in nasal obstruction is short lived

9and the facility is not available throughout . InAntonio series of SMD 20% had moderate painand 80% mild pain. 44% of our patient with SMDcomplained of moderate pain on post operative day

15and 32% of patient with PIT had severe pain .

Crusting, in literature has been mentioned14

as another common problem with nasal surgery .Nousheen also reported crusting in her series of

7PIT . In our series 21 (84%) cases of PIT hadmoderate crusting at post of day 7 assessmentand 5 patients at one month follow up. S Maskelreported 29.5% of patient with laser turbinctumy

9to present with crusting in first two weeks .Moderate crusting was reported by Antonio in 50%

th 15of patient with SMD at 14 post operative day . Inour study crusting was noticed in only 48% ofSMD patients as compared to 84% of PIT patient

thon 7 post operative day, while at the end of twoweeks no patient with SMD had crusting while20% patients with PIT still complained of crusting.Good healing was noted 92% of SMD patients as

stcompare to 52% of PIT patients at end of 1

month.The inferior turbinate transected edge

results in an exposed edge of the inferior turbinatebone. Crust ing will continue until the bone is

1covered with a mucosl surface . Total inferiorturbinectomy, though not considered physiologicaland safe by many due to loss of humidificationand temperature regulation function of inferior

10, 11turbinate is favored by many otolaryngologists.

Nasirullah et al reported good nasal patency resultsin his series of total inferior turbinectomy but

12found crusting as common complication . This isin accordance with our study. Green also studied

the effects of submucosal diathermy on inferiorturbinate and reported as case occulomotor nerve14

palsy following SMD . We did not encounter anysuch complication.

CONCLUSION

We found Submucousal diathermy a safeand effective method with less bleeding, pain andcrusting. However, post-operative nasal perm-eability is almost similar in both groups.

None Declared

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9. Maskell S, Eze N, Patel P, Hosni A. Laserinferior turbinectory under local anaesthetic: awell toerated out patient procedure. J LaryngolOtol 2007;121:957-61.

10. Orabi AA, Sen A, Timms MS, Morar P. Patientsatisfaction survey of outpatient-based topicall o c a l a n a e s t h e t i c K T P l a s e r i n f e r i o rturbinectomy: a prospective study. Am JRhinol 2007;21:198-202.

11. C h a n d G , K u m a r S , K h e m a n i A M .Comparative study efficacy of mucosalelectrocautery versus sub mucosal diathermyfor the t reatment of inferior turbinatehyper t rophy of nose . Pak J Med Sci2010:26:454-7.

12. G r e e n K M J , B o a r d T , O ' K e e f f e L J .

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Oculomotor nerve palsy following submucosal 15. Nassif Filho AC, Ballin CR, Maeda CA,diathermy to the inferior turbinates. J Laryngol Nogueira GF, Moschetta M, de Campos DS.Otol 2000;114:285-6. Compara t i ve s t udy o f t he e f f ec t s o f

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turbinate with or without out facture. Braz JTotal inferior turbinectomy for hypertrophiedOtorhinolaryngo 2006;72:89-95.inferior turbinates: postoperative results in 135

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CONTRIBUTORS

I, J and Spreparation of the manuscript. All authors listedcontributed signi?cantly to the research that resulted inthe submitted manuscript.

contributed equally to the research and

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