What is laser ablation of septal spurs and nasal swell bodies?

Laser Ablation of Septal Spurs and Nasal Swell Bodies

Definition and Anatomical Targets

Laser ablation of septal spurs and nasal swell bodies is a minimally invasive outpatient procedure that uses laser energy to vaporize or reduce hypertrophied tissue in the anterior nasal septum and nasal valve area, specifically targeting bony or cartilaginous septal protrusions (spurs) and the erectile tissue masses (nasal swell bodies) that contribute to nasal obstruction. 1

Septal Spurs

• Septal spurs are bony or cartilaginous projections from the nasal septum that commonly occur at the junction of the quadrangular cartilage and bony septum, consistently developing ipsilaterally with the posterior extension of the quadrangular cartilage (averaging 30mm beyond the bony-cartilaginous junction). 2
• These structural deformities contribute significantly to nasal obstruction and often require surgical correction. 2

Nasal Swell Bodies

• Nasal swell bodies (also called nasal septal swell bodies or NSB) are erectile tissue structures located on the anterior nasal septum that can become abnormally thickened (mean maximal width >16mm on CT imaging) and cause nasal valve narrowing. 3
• These structures differ from inferior turbinates but similarly contribute to nasal obstruction when hypertrophied. 1, 3

Laser Technique and Procedure Details

Procedural Characteristics

• The procedure utilizes carbon dioxide laser or 940nm diode laser for both contact ablation (for tissue vaporization) and non-contact ablation, performed under local anesthesia in an outpatient or office setting. 4, 1
• Average surgical time is approximately 5-10 minutes with no nasal packing required. 4, 5
• The laser vaporizes tissue while preserving surrounding mucosa, creating minimal thermal injury to adjacent structures. 6

Specific Applications

• Laser-assisted outpatient septoplasty (LAOS) has specific clinical application for chronic nasal obstruction due to moderate anterior septal deviation in adults, addressing the anterior nasal valve area responsible for more than 2/3 of airflow resistance. 4, 7
• Nasal swell body reduction can be performed alone or combined with inferior turbinate reduction and posterior nasal nerve ablation for comprehensive treatment of both anatomical obstruction and rhinitis symptoms. 1

Clinical Outcomes and Efficacy

Success Rates

• Surgical success rates of 90-96% for nasal obstruction relief have been reported, with mean nasal obstruction scores improving from 6.2 to 1.6 postoperatively. 4, 5
• Total Nasal Symptoms Score decreased by 73%, with rhinorrhea and congestion scores decreasing by 54% and 81% respectively when nasal swell body reduction was combined with inferior turbinate reduction. 1
• Visual analog scale scores for nasal obstruction decreased from 7.63 preoperatively to 3.88 at 3 months, with 75% patient satisfaction at 1 year follow-up. 3

Objective Measurements

• Significant increases in mean minimal cross-sectional areas of the narrow nasal side and mean nasal cavity volume occur postoperatively. 4
• Mean total nasal resistance decreases significantly after the procedure. 5

Safety Profile and Complications

Minimal Adverse Events

• The procedure is virtually bloodless and painless (VAS pain score <4), with no significant laser-specific complications observed in large case series. 4, 5, 1
• Minor complications include minimal crusting, epistaxis, and infections that resolve within 2 weeks without intervention. 1
• Only 2 cases of minor bleeding per 120 patients were reported, easily treated without sequelae. 4

Recovery Characteristics

• Patients experience decreased recovery time, less morbidity, lower medical costs, and faster return to full activity compared to traditional septoplasty. 4
• An 80% reduction in medication usage was noted following the procedure. 1

Clinical Context and Guidelines Framework

Appropriate Patient Selection

• According to the American Academy of Allergy, Asthma, and Immunology, any septal procedure should only be performed after documented failure of at least 4 weeks of appropriate medical therapy including intranasal corticosteroids, saline irrigations, and treatment of underlying allergic components. 7
• Only 26% of septal deviations are clinically significant despite 80% of the population having off-center septums, making proper patient selection critical. 7

Comparison to Traditional Techniques

• Traditional turbinate reduction techniques include electrocautery, radiofrequency ablation, and laser vaporization that work either on surface mucosa or intramurally, with laser techniques offering the advantage of minimal bleeding and no packing requirement. 6
• Laser turbinectomy vaporizes tissue in areas while leaving islands of intact mucosa, can be performed under local anesthesia, and results in minimal postoperative crusting. 6

Important Caveats

• While laser ablation effectively treats anatomical obstruction, it does not address underlying rhinitis or allergic conditions, which require continued medical management even after successful surgery. 7
• The procedure is most effective for anterior septal pathology affecting the nasal valve area rather than posterior deviations. 7, 4