From the Guidelines
Turbinectomy can lead to serious complications, including nasal bleeding, synechiae formation, crusting, and atrophic rhinitis, also known as "empty nose syndrome", which can significantly impact a patient's quality of life. The most common complications of turbinectomy include:
- Nasal bleeding, which can occur immediately after surgery or as delayed hemorrhage days later
- Synechiae formation, which can lead to adhesions between the turbinate and septum
- Crusting, dryness, and nasal congestion during the healing process, which typically resolves within 2-3 weeks
- Atrophic rhinitis, a rare but serious long-term complication characterized by paradoxical nasal obstruction, chronic dryness, and breathing discomfort despite anatomically patent nasal passages, resulting from excessive tissue removal 1. Other potential complications include olfactory disturbances, and rarely, cerebrospinal fluid leak if the skull base is inadvertently violated. Infection is possible but uncommon with appropriate perioperative antibiotics. Post-operative care includes saline irrigations 3-4 times daily, avoiding nose-blowing for 48 hours, and sleeping with the head elevated to minimize bleeding risk. Most complications can be minimized with conservative tissue removal techniques that preserve the mucosal function while addressing the obstructive component, as suggested by the clinical practice guideline for allergic rhinitis 1.
From the Research
Complications of Turbinectomy
- The complications of turbinectomy can be minimal, with one study finding that only 36% and 61% of patients with rhinorrhoea and anosmia respectively were relieved of these symptoms after total inferior turbinectomy 2.
- Another study found that turbinate reduction with complete preservation of mucosa and submucosa during rhinoplasty resulted in excellent functional outcome, with no specific complications such as bleeding, foul drainage, dryness, and crusting reported 3.
- Middle turbinate resection is unlikely to cause empty nose syndrome in the first year postoperatively, with only 2.1% of patients having ENS6Q scores ≥ 11 and 6.3% having nasal crusting at last follow-up 4.
- Partial turbinectomy seems to have a negative impact on intranasal air heating but not to humidification, although this effect has no impact on clinical condition and subjective perception of surgical outcome 5.
- Unremitting postoperative epistaxis following turbinectomy can be successfully controlled by a protocol using intravenous desmopressin without the need for alternative maneuvers 6.
Specific Complications
- Empty nose syndrome (ENS) is a potential complication of turbinate resection, characterized by nasal dryness, crusting, and paradoxical nasal obstruction 4.
- Nasal crusting was documented in 6.3% of patients after middle turbinate resection, although none of the patients with ENS6Q scores ≥ 11 had nasal crusting at last follow-up 4.
- Decongestant nasal spray abuse was diagnosed in 50% of patients reporting worsening of symptoms after turbinate reduction 3.
- Epistaxis is a potential complication of turbinectomy, although it can be controlled with intravenous desmopressin 6.