Relationship Between Inferior Turbinate-relocating Surgery And Improvement Of Nasal Ventilation

Background and ObjectiveNasal obstruction is a serious problem which affects patients’nasal function and quality of life. Inferior turbinate surgery is one of the most common operation to improve nasal obstruction. In the past, inferior turbinate surgery consists of partial resection and shrinking operation, such as frozen operation, laser, etc. The purpose is to reduce the volume of nasal mucosa and turbinate structures to improve the nasal ventilation, however, nasal function is often seriously damaged at the same time. In recent years, due to the development of minimally invasive nasal techniques and understanding of nasal structure and function, clinicians began to realize that intact inferior turbinate structure is essential for its function. Relocating inferior turbinate surgery, broadening the nasal passage and remaining the structure and mucosa of inferior turbinate intact, is an ideal method theoretically, but, the degree of nasal structure changes before and after operation, the clinical correlation between the inferior turbinate location and nasal ventilation warrant in-depth study. The purpose of this study is to apply nasal endoscope, CT scan, acoustic rhinometry, rhinomanometry, as well as VAS scoring, objective function and subjective feelings, etc., to evaluate the feasibility and advantage of relocation of inferior turbinate, and discuss the relationship between the changes of nasal cavity and nasal ventilation after inferior turbinate-relocating and nasal cavity-broadening surgery.Methods Inferior turbinate-relocating surgery was performed in50chronic hypertrophic rhinitis patients confirmed by endoscopy and CT scanning. Preoperative and postoperative nasal endoscopy were carried out in all the patients, in which the distance from the anterior end of inferior turbinate to nasal septum (DTNS) was measured. In addition, CT was to measure,1) the minimal distance between the inside edges of bilateral inferior turbinate (MDTT);2) the minimal distance between bilateral inferior turbinate bones (MDTB);3) the minimal distance between the inferior turbinate at asial nasal limen (NLDT);4) inferior turbinate thickness (ITT). Acoustic rhinometry (AR) and rhinomanometry (RM) were used to evaluate the ventilatory function of nasal cavity before and after the surgery. Visual analogous scale (VAS) was applied to evaluate the severity of preoperative and postoperative nasal obstruction. The above data were analyzed by matched t-test, and Spearman rank correlation was to determine the relationship between bilateral VAS grades, before and after the surgery, and nasal inspiratory effective resistance (IER), nasal expiratory effective resistance (EER) and DTNS. The relationship between the total resistance of nasal inspiratory phase, as well as the total resistance of nasal expiratory phase, and MDTT or MDTB was also analyzed.ResultsAccording to the analysis, significant differences between the preoperative and postoperative were noted in right DTNS, left DTNS, MDTT, MDTB, NLDT, right TT, left ITT, IER, EER and0-5cm nasal cavity volume (0-5cmNCV), nasal minimal cross-sectional area (NMCA), right VAS, left VAS (t-values were-8.827,-8.590,-17.525,-23.562,-8.374,8.693,6.684,12.021,14.510,-6.074,-2.285,14.042and9.925, respectively; all P<0.05). In accordance with the above results, the distance between the minimal cross-sectional area and the prenaris showed no significance (t=-0.349; P＞0.05). Bilateral VAS grades demonstrated a positive relationship with IER and EER (left side:r-value was0.541and0.660, respectively; right side: r-values were0.940and0.688, respectively; all P＜0.05). Additionally, negative relationship was identified between VAS grades and DTNS (r=-0.861; P＜0.05). The correlation of total resistance of nasal inspiratory phase (r-values were-0.565and -0.546, respectively) and expiratory phase (r-values were-0.562and-0.546) with MDTT or MDTB were all negative (all P＜0.05).Conclusions1. Nasal endoscopy and CT measurement are objective methods to demonstrate the changes in nasal structures after the surgery.2. AR, RM and VAS grades are reliable to evaluate the nasal ventilation.3. Inferior turbinate-relocation is a safe and effective surgery, in which narrowed nasal cavity could be widened and nasal ventilatory function could be improved.