[Presumed physiopathology of the nasal wall surgery and contemporary techniques of the inferior turbinates surgery].
The lateral wall of the nasal cavity is anatomically complex and covers several nasal functions: ventilation, conditioning of the air, protection. This region also plays a prime role in maintaining nasal-sinus homeostasis through dynamic regulation of the two-way exchange between the nasal cavity and paranasal sinuses. In light of the most recently acquired information, physio-pathological aspect of the lateral wall are discussed in terms of ventilation mechanisms and mucociliary clearance of the paranasal sinuses. In this light, the key to nasal-sinus physiology is clearly the perviousness of the side wall ostium and, above all, the status of the structures making up the "ostiomeatal complex". The anatomo-functional integrity of the lateral wall is fundamental for sinus ventilation 90% of which depends on passive diffusion of air through ostium. It is also a key to mucociliary clearance, always directed toward the main ostium. This rationale provides the basis for the so-called functional surgery of the lateral wall aimed at restoring ostium permeability. One structure in the lateral wall is a key to nasal physiology: the lower turbinate. Anatomical or functional alterations of the lower turbinate is one of the major causes of nasal stenosis. Pharmacological treatment of this pathologies is not always satisfactory, hence one leans toward surgical treatments. Nevertheless, the wide range of techniques available attests to the fact that there is still great deal of uncertainty in this regard. After having analysed the data available in the literature, the authors propose a comparison of some of the most frequently used forms of surgery: electrocauterization, cryotherapy, laser therapy, submucosal decongestion with or without luxation, turbinectomy. Follow-up based on rhinomanometric evaluation, rhinometry, TTMC, IgA assay and symptom scoring has been performed for 4 years. The results show that the submucosal decongestion technique, particularly the variation with lateral luxation, is considered most effective in resolving obstruction while respecting nasal physiology.
Passàli
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Istituto di Discipline Otorinolaringologiche, Università di Siena.
Biagini
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Pedace
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D006801:Humans; D009296:Nasal Cavity / Q000503:physiopathology* / Q000601:surgery*; D012225:Rhinoplasty; D014420:Turbinates / Q000503:physiopathology* / Q000601:surgery*