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The most serious complication of inferior turbinate reduction surgery is postoperative bleeding, soon after the operation or later on. In this study comprising 751 patients, the authors have compared three common methods. Partial turbinectomy involved resection of the inferior turbinate, including bone, without creating any mucosal flaps. In turbinoplasty, a medial flap was created submucosally and the bone resected. In both of these, blind cautery was applied and packing was done with removable tampon. The third method was endoscopic turbinoplasty in which a medial flap was created, and the bone debrided. Hemostasis was achieved by identifying and cauterising the feeding vessels and packing was done with absorbable material holding the mucosal flap in place. The severity of bleeding was graded as requiring intervention, simple cauterisation and treating conservatively. The early and late bleeding rates were higher in partial turbinectomy and turbinoplasty groups compared to endoscopic turbinoplasty group. Multivariate logistic regression analysis, applied to the incidence of postoperative bleeding with each operative method and confounding factors such as postoperative dressings, showed higher bleeding rates for partial turbinectomy and turbinoplasty when compared with endoscopic turbinoplasty. The use of tranexamic acid did not prove significant. The authors contend that even though partial turbinectomy and turbinoplasty are inexpensive and quick to perform, endoscopic turbinoplasty has a place in informed surgical choice and should be encouraged.

Inferior turbinate resection: comparing post-operative bleeding between different surgical techniques.
Levy E, Ronen O, Seal E, et al.
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Madhup K Chaurasia

Mid and South Essex NHS Foundation Trust, UK.

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