title: Long-term outcomes in medial flap inferior turbinoplasty are superior to submucosal electrocautery and submucosal powered turbinate reduction.
abstract: BACKGROUND
  Techniques for inferior turbinate reduction vary from complete turbinectomy to limited cauterization. Surgical methods differ on the degree of tissue reduction and reliance on surgical tissue removal vs tissue ablation. The outcome and morbidity from 3 different turbinate techniques are compared.
  
  
  METHODS
  A randomized double-blinded study was performed. Patient nasal cavities were randomized to different interventions on each side within the same patient. One group had a combination of submucosal powered turbinate reduction (designated "submucosal") and submucosal electrocautery (designated "electrocautery"); and the second group had a combination of submucosal powered turbinate reduction (designated "submucosal") and medial flap turbinoplasty (designated "turbinoplasty"). Patient-scored nasal obstruction and rhinorrhoea (1 to 5) along with blindly assessed nasal airway patency ratings (1 to 4) was done at 12 and 60 months postoperatively. Pain requiring additional analgesia, crusting, bleeding (needing review), and revision were documented.
  
  
  RESULTS
  A total of 100 patients were recruited (age 32.79 ± 13.58 years; 39% female). This represented 200 nasal airway surgeries with 100 submucosal procedures, 50 electrocautery and 50 medial flap turbinoplasties. No patients complained of worsening of their obstruction. At 60 months patients in the turbinoplasty group had greater outcomes, with 90.2% having occasional or no decongestant use (Kendall's tau B p < 0.001) compared to electrocautery (15.8%) and submucosal (37.8%). Fewer turbinoplasty patients had a revision procedure (12%, χ(2) = 20.08, p < 0.001) compared to electrocautery (54%) and submucosal (40%). Crusting was more common in the electrocautery group (58% vs submucosal 2% and turbinoplasty 0%; χ(2) = 92.04; p < 0.001).
  
  
  CONCLUSIONS
  The medial flap turbinoplasty provided consistent, robust results. Long-term relief of obstructive symptoms without additional risk of complication was observed in the turbinoplasty group.
authors.affiliation: St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.|Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.|Australian School of Advanced Medicine, Macquarie University, Sydney, Australia.
authors.forename: Henry P
authors.initials: HP
authors.lastname: Barham
authors.affiliation: Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.
authors.forename: Mona A
authors.initials: MA
authors.lastname: Thornton
authors.affiliation: St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.|Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.|Australian School of Advanced Medicine, Macquarie University, Sydney, Australia.
authors.forename: Anna
authors.initials: A
authors.lastname: Knisely
authors.affiliation: Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.
authors.forename: George N
authors.initials: GN
authors.lastname: Marcells
authors.affiliation: St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.|Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.|Australian School of Advanced Medicine, Macquarie University, Sydney, Australia.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Harvey
authors.affiliation: Australian School of Advanced Medicine, Macquarie University, Sydney, Australia.|Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: Raymond
authors.initials: R
authors.lastname: Sacks
mesh_terms: D000328:Adult; D004564:Electrocoagulation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009297:Nasal Mucosa / Q000601:surgery*; D015508:Nasal Obstruction; D012225:Rhinoplasty; D013524:Surgical Flaps / Q000706:statistics & numerical data*; D013997:Time Factors; D016896:Treatment Outcome; D014420:Turbinates / Q000601:surgery*; D055815:Young Adult
keywords: inferior turbinate; medial flap; reduction; rhinitis; turbinoplasty