What is the complexity of a rhinoplasty with turbinate (turbinate bone) reduction and septoplasty (nasal septum repair)?

From the Guidelines

A rhinoplasty combined with turbinate reduction and septoplasty is a moderately complex surgical procedure that typically takes 2-3 hours to complete, addressing both cosmetic concerns and functional breathing issues simultaneously. This combination surgery is performed under general anesthesia and usually requires about 1-2 weeks of initial recovery time, with full healing taking up to a year 1. During recovery, patients typically need prescription pain medications like oxycodone or hydrocodone for 3-5 days, followed by over-the-counter pain relievers like acetaminophen or ibuprofen. Nasal packing may be placed for 24-48 hours post-surgery, and a splint is typically worn for about a week.

The procedure's complexity stems from the surgeon needing to balance functional improvements with aesthetic goals, working on multiple nasal structures simultaneously. Despite this complexity, the combined approach is often beneficial as it addresses both form and function in a single operation, reducing overall recovery time compared to having separate procedures. According to recent guidelines, inferior turbinate reduction may be offered to patients with allergic rhinitis and nasal airway obstruction who have failed medical management, with a preponderance of benefit over harm 1.

Some key points to consider include:

• The surgical procedures for correction of a deviated septum usually used are submucosal resection and septoplasty, with septoplasty being the preferred procedure 1.
• Inferior turbinate reduction surgery is often performed concurrently with septoplasty, although some studies fail to show any long-term benefit 1.
• The goal of turbinate reduction techniques is to reduce the size of the inferior turbinate outright, or to diminish its ability to swell and block the nasal passages 1.
• Patients should expect significant swelling and bruising for the first two weeks, with breathing improvement occurring gradually as swelling subsides.

Overall, the combination of rhinoplasty, turbinate reduction, and septoplasty can be an effective way to address both cosmetic and functional issues in the nose, but it requires careful consideration and planning by the surgeon to ensure optimal outcomes.

From the Research

Complications of Rhinoplasty with Turbinate Reduction and Septoplasty

• The complexity of rhinoplasty with turbinate reduction and septoplasty can be understood by examining the outcomes of these procedures, as reported in various studies 2, 3, 4, 5, 6.
• A clinical consensus statement on septoplasty with or without inferior turbinate reduction was developed by an expert panel of otolaryngologists, which provides guidance on the definition, diagnosis, and management of these procedures 2.
• The effect of turbinate surgery in rhinoseptoplasty on quality-of-life and acoustic rhinometry outcomes was evaluated in a randomized clinical trial, which found that turbinate reduction did not improve short-term general and specific quality-of-life outcomes and acoustic rhinometry recordings 3.
• Nasal surgery, including septoplasty with and without inferior turbinate reduction and functional rhinoplasty, can improve sleep-related quality of life measures in patients with obstructive sleep apnea, although the effectiveness of these techniques in decreasing apnea-hypopnea index is still debated 4.
• Concomitant inferior turbinate reduction during septoplasty may decrease the likelihood of revision nasal surgery, as reported in a retrospective review of consecutive patients undergoing septoplasty with or without inferior turbinate reduction 5.
• A prospective study of outcomes of septoplasty with turbinate reductions in patients with allergic rhinitis found that these patients can experience significant improvement in nasal obstruction symptoms and quality of life, despite having greater allergy-related quality of life impairment 6.

Surgical Considerations

• The decision to perform turbinate reduction during septoplasty should be based on individual patient needs and anatomy, as the benefits and risks of this procedure can vary depending on the specific case 2, 3.
• The use of quilting sutures can obviate the need for nasal packing after septoplasty, which can improve patient comfort and reduce the risk of complications 2.
• Endoscopy can be used to improve visualization of posterior-based septal deviation during septoplasty, which can help to ensure accurate and effective correction of the septal deviation 2.

Outcomes and Quality of Life

• Patients undergoing septoplasty with or without inferior turbinate reduction can experience significant improvement in nasal obstruction symptoms and quality of life, as reported in various studies 3, 5, 6.
• The magnitude of change in quality of life scores can be comparable between patients with and without allergic rhinitis, although patients with allergic rhinitis may report greater allergy-related quality of life impairment 6.
• Setting appropriate expectations pre-operatively is important to ensure that patients with allergic rhinitis understand the potential benefits and limitations of septoplasty and turbinate reductions 6.