Radiofrequency volume turbinate reduction versus partial turbinectomy: clinical and histological features.
BACKGROUND
Nasal obstruction is a common symptom related to turbinate hypertrophy in 20% of cases. When medical treatment failed different surgical options were available. Actually, nasal physiology impairment after surgical treatment is not fully clear. This study evaluates  microscopic mucosal changes and physiological function, by means of mucociliary transport time (MCT), after radiofrequency volume turbinate reduction and partial inferior turbinectomy.


METHODS
Forty-eight nonallergic patients were treated for chronic nasal obstruction.  Twenty-six patients (group A) underwent radiofrequency turbinate reduction and 22 patients (group B) underwent partial turbinectomy associated with septoplasty. Mucosal specimens obtained before T(0) and 6 months (T(1)) after surgery were compared by means of optical microscope  and transmission electron microscope. All patients were evaluated using MCT at T(0) and T(1).


RESULTS
Optical analysis showed circumscribed squamous metaplasia and fibrosis in specimens obtained from group A. Same changes were more evident in group B.  Ultrastructural analysis evidenced loss of ciliated epithelium in group B, whereas in group A a normal number of cilia was found. In all patients at T(1), MCT time was prolonged in comparison with the preoperative values. After surgery, group B showed significantly prolonged MCT in  comparison with group A (p < 0.05).


CONCLUSIONS
In our study both surgical techniques achieved good clinical outcomes with improved nasal function, although the ciliated epithelium appeared partially impaired. These findings resulted in a prolonged MCT in all patients,  especially in those treated with partial turbinectomy. Compared to partial resection, intraturbinal turbinate reduction seems to be the method of choice to better preserve nasal physiology.
Ear, Nose, and Throat Clinic, Department of Head and Neck, University of Turin, Turin, Italy.
Massimiliano
M
Garzaro
Vincenzo
V
Landolfo
Matteo
M
Pezzoli
Simona
S
Defilippi
Paola
P
Campisi
Carlo
C
Giordano
Giancarlo
G
Pecorari
D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D016022:Case-Control Studies; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009079:Mucociliary Clearance; D015508:Nasal Obstruction / Q000473:pathology / Q000601:surgery*; D011446:Prospective Studies; D014420:Turbinates / Q000473:pathology* / Q000601:surgery*