Inferior turbinate surgery in sleep-disordered breathing patients with nasal obstruction: Principles and various techniques

Abstract

Sleep-disordered breathing (SDB) is characterized by the intermittent narrowing or collapse of the upper airway, including the nasal cavity, pharynx, and larynx during sleep. Nasal obstruction is one of the most frequent presenting symptoms in SDB patients, and therefore, medical treatments such as saline nasal irrigation, antihistamine, and topical nasal spray are the first recommendation. If the issue is not resolved, surgical treatments for nasal congestion are helpful in order to alleviate nasal obstruction, reduce snoring, and improve positive airway pressure compliance. Inferior turbinate surgery is one of the most commonly performed nasal surgeries (e.g., endoscopic sinus surgery, septoplasty, etc) used to improve nasal obstruction. There are various inferior turbinate surgical methods including electrocautery, laser-assisted turbinoplasty, radiofrequency-assisted turbinoplasty, outfracture, submucous turbinoplasty, partial turbinectomy, and microdebrider-assisted turbinoplasty. Despite the development of these numerous approaches, no clear guidelines exist as yet to help determine the most appropriate modality for any individual patient. This is due to variation in pathophysiology and the degree and extent of the turbinate hypertrophy between patients. Consequently, a comprehensive understanding of these techniques, as well as the preservative concept of functional nasal physiology, is critically important for all surgeons. We propose that the ideal inferior turbinate surgery would meet the following criteria: 1) be less invasive, 2) incorporate remodeling rather than excessive resection, 3) entail a submucosal versus superficial mucosal technique, 4) represent an individually selected technique that is best suited to the patient, and 5) address long term considerations rather than acute symptomatic relief.