Assessing Approaches to the Inferior Turbinate in Rhinoplasty: A Systematic Review of the Literature

Purpose: Rhinoplasty is one of the most challenging procedures plastic surgeons are asked to perform. While there are standard maneuvers utilized by most every rhinoplasty surgeons, other techniques are not as uniformly utilized. The approach to the inferior turbinate is one such distinction. While many different techniques exist for treating inferior turbinate hypertrophy, a systematic review of these techniques does not yet exist in our literature.

Methods: A MEDLINE, PubMed, and Cochrane Database search was performed for inferior turbinate surgery which yielded 1,210 studies. This search was then narrowed by analyzing titles containing the keywords turbinectomy, inferior turbinectomy, partial turbinectomy, submucousal turbinectomy, electrocautery, laser cautery, cryotherapy, cryosurgery, hypertrophied inferior turbinates, nasal obstruction, nasal turbinates. Studies with titles not containing these keywords were excluded.

Results: This yielded 42 relevant studies. In terms of subjective improvement of nasal obstruction, partial turbinectomy rated highest with 87% of patients stating decreased nasal obstruction. This was followed by electrocautery (86.7%), laser cautery (85.4%), submucousal resection (80.23%), total turbinectomy (69%), and cryotherapy (60%). Submucousal resection and laser cautery were found to have the greatest change in nasal airway resistance, .75 Pa/cm³, followed by total turbinectomy (.69), cryotherapy (.6), and partial turbinectomy (.55). Surgeons were found to prefer partial turbinectomy (47.65%) followed by turbinate outfracture (42.5%). Post-operative bleeding and atrophic rhinitis was most commonly reported with total turbinectomy (12.9% and 39% respectively) while synchiae and crusting were most prevalent with electrocautery (34% and 63% respectively).

Conclusion: Many approaches toward treating inferior turbinate hypertrophy in rhinoplasty have been utilized in the literature. A systematic review of the evidence reveals that partial turbinectomy appears to provide largest decrease in nasal obstruction, while total turbinectomy and electrocauterization have higher levels of complications. Accurate pre-operative diagnosis and surgical planning are critical in assessing which procedure will benefit each rhinoplasty patient.