Treatment of the Inferior Turbinates

Treatment of the inferior turbinates is a matter of some controversy. Some authors advocate inferior turbinate sacrifice as an almost routine treatment of nasal obstruction; others categorically advise against surgical reduction because of the risk of atrophic rhinitis. In my view, there should be a balanced approach. A thorough search to determine the cause of nasal obstruction is essential, and that cause should be addressed. The proper treatment of nasal obstruction is not simply turbinectomy. By the same token, it is unlikely that the inferior turbinates are immune from pathologic conditions; turbinate hypertrophy must be recognized. A graduated stepwise approach to the inferior turbinates is prudent. It is clear that atrophic rhinitis develops in some patients after inferior turbinectomy, so undertake this procedure with great caution.

Figure 11. This 32-year-old man presented with nasal obstruction and had been given the diagnosis of a deviated septum elsewhere. He was also interested in rhinoplasty to address the deviated nasal tip and tip asymmetries. An examination including endoscopy revealed that it was impossible to pass an endoscope; a CT scan revealed an ossifying fibroma extending to the skull base and posteriorly approaching the optic nerve. A postoperative CT scan is shown.

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