Radiofrequency Devices

The advent of radiofrequency devices (Somnus Medical Technologies Inc., Sunnyvale, CA; Coblation Corp., California) to reduce the size of the inferior turbinates has been a significant advance providing a conservative proce­dure that may be performed with the patient under local anesthesia as an alternative to more aggressive approaches (Figure 9). When more aggressive treatment of the inferior turbinates is warranted, a submucosal elevation of the turbinate with resection of the bulky bone of the infe­rior concha is preferred. Partial sacrifice of the inferior turbinate, such as resection or crushing, has never seemed appropriate or physiologic even when successful. After submucosal resection, the turbinate may be reattached with absorbable sutures and now occupies considerably less space than its original bulk, even as its physiological functions of warming, lubricating, and air-conditioning are preserved.

Lee and associates describe 3 mucosa-sparing tech­niques for the surgical management of inferior turbinate hypertrophy. I subscribe to all these techniques. Radiofrequency (RF) volumetric tissue reduction uses radiofrequency heating to induce submucosal tissue destruction, leading to reduction of tissue volumes. The RF generator (Somnus Medical Technologies) is connect‑ ed to a specialized single-use delivery tip and handpiece. The tip is a 22-gauge electrode, 4 cm long; the active por­tion is 1 cm, and the remaining 3 cm is insulated. Two thermocouples allow constant temperature feedback at the location of treatment and in the surrounding tissue, thereby limiting mucosal injury. Topical and infiltrative anesthesia is used. To avoid tissue shrinkage, some sur­geons prefer not to use vasoconstrictive agents, which could increase the risk of mucosal injury. Under direct vision, place the RF electrode in the anterior-inferior por­tion of the turbinate, with several millimeters of the inac­tive portion in contact with the mucosa to avoid mucosal injury. Deliver the RF energy at a specified energy setting. Measure the temperature at the delivery site constantly, and modulate the rate of energy delivery to ensure a maximal temperature of less than 75°C. This allows the procedure to be performed with the patient under local anesthesia, without pain. Time and experience have shown that the recommended energy levels create a sub­mucosal injury that causes favorable tissue shrinkage. Often a second lesion immediately posterior to the first is both safe and effective. Lee and associates feel that it is reasonable to expect 70% to 80% subjective improve­ment in patients treated with this technique.

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