title: Septoturbinotomy.
abstract: The inferior turbinates are a principal cause of nasal airway obstruction. To some extent, the bony septum (the perpendicular plate of the ethmoid) also, on occasion, contributes to that airflow obstruction. There are many excellent methods to resect or ablate the turbinates, including submucous resection and cauterization. However, some have been associated with bleeding, crusting, and the development of synechiae. In this Featured Operative Technique article, we propose 2 mechanical means to expand the nasal vault: (1) the insertion of a large and long speculum that outfractures the turbinates and also centralizes the bony septum when the handles are compressed and (2) the insertion of a large clamp, which is expanded (in reverse "nutcracker" fashion) to achieve a similar result. Mechanical dilation (expansion) of the nasal vault with the speculum or large clamp substantially improves vault diameter such that further work on the turbinates in the form of turbinectomy is seldom necessary. The nasal vault is not necessarily expanded to the maximal diameter that could be achieved with resection procedures but need not be to achieve satisfactory air flow. Septoturbinotomy is a quick and simple way to deal with inferior turbinate hypertrophy. It is a minimally invasive procedure that improves the airway in virtually all cases, such that turbinectomy is seldom employed. It can be used prophylactically on all rhinoplasty cases requiring lateral osteotomy, which potentially shrinks the nasal vault slightly.
authors.affiliation: Dr Tanna is an Assistant Professor in the Division of Plastic & Reconstructive Surgery, North Shore-LIJ Health System, Manhasset, New York.
authors.forename: Neil
authors.initials: N
authors.lastname: Tanna
authors.forename: Malcolm A
authors.initials: MA
authors.lastname: Lesavoy
authors.forename: Hatem A
authors.initials: HA
authors.lastname: Abou-Sayed
authors.forename: Ronald P
authors.initials: RP
authors.lastname: Gruber
mesh_terms: D000328:Adult; D004106:Dilatation; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D015508:Nasal Obstruction / Q000209:etiology / Q000601:surgery*; D009300:Nasal Septum / Q000601:surgery*; D010027:Osteotomy; D012225:Rhinoplasty / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D013525:Surgical Instruments; D016896:Treatment Outcome; D014420:Turbinates / Q000601:surgery*
keywords: nasal airway; rhinoplasty; septal deformity; septoplasty; turbinectomy; turbinoplasty