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Rhinolaryngoscopy for the Allergist
Published in Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial, Textbook of Allergy for the Clinician, 2021
Jerald W Koepke, William K Dolen
Hypertrophy of the nasal turbinates may occur secondary to chronic inflammation of the nasal mucosa, or in cases of septal deviation as a compensatory mechanism in the nasal passage opposite to the obstructed side. Turbinate hypertrophy may also occur without an obvious underlying cause. Complete or partial turbinectomy may have been performed in an attempt to relieve obstructive symptoms or as part of more complicated nasal or sinus surgery.
Medical Negligence in Otorhinolaryngology
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Issues of consent on their own are rare in relation to sinus surgery and they are much more common when coupled with allegations of incompetent surgical technique. However, it is in the field of turbinectomy, particularly in the adolescent and young adult, that issues of consent arise. Torrential haemorrhage following inferior turbinectomy is not uncommon, probably happening in most surgeons’ practice, with an incidence of between 1 in 60 and 1 in 200 cases. It does appear to be more common where a posterior turbinectomy has been undertaken, rather than removal of the anterior end of the interior turbinates. Nevertheless, torrential haemorrhage can happen in any form of turbinate surgery. When this occurs, and the patient has undergone the usual treatment to arrest the haemorrhage and correct the blood loss, an allegation of permanent psychological damage may arise, accompanied by the allegation that the patient was not warned of the risk and had they been, then they would have refused consent for the surgery. In taking consent, the wise surgeon must assess the personality of the patient and ask himself whether they would have the mental fortitude to withstand the psychological trauma that can accompany a severe nasal haemorrhage, particularly as it may appear life-threatening to the patient and their family. If the patient, despite warning of such haemorrhage, still wishes to proceed with the surgery, then it should be carefully annotated in the notes that the warning has been given and understood.
Biopsy of recurrent nasolacrimal duct obstruction using sheath-guided dacryoendoscopy
Published in Orbit, 2019
Kosuke Ueda, Akihide Watanabe, Norihiko Yokoi, Manabu Sugimoto, Hideki Fukuoka, Katsuhiko Shinomiya, Shigeru Kinoshita, Saul Rajak, Dinesh Selva
It has been reported that NLD biopsy can be conducted during external DCR.16 Although not previously reported, it is somewhat widely known that duct biopsy can also be performed during endonasal endoscopic DCR, as the proximal duct above the insertion of the inferior turbinate is readily accessible. If biopsy of the middle or terminal duct is required, this would necessitate at least a partial inferior turbinectomy.17,18 However, in some countries, including Japan, dacryoendoscopic-guided stenting (i.e., SGI) is widely selected as the first-line treatment for NLDO. Our dacryoendoscopic-guided biopsy technique simply harvests the obstructing/stenotic tissue that would previously have been discarded during blind/dacryoendoscopic-guided probing. Thus, it is minimally invasive, does not add significantly to the duration of the operation, and does not require additional equipment.
Variation of the minimally invasive CDCR technique
Published in Orbit, 2020
Austin Pharo, James Chelnis, Tara Goecks, Kendra C. DeAngelis, Brian Fowler, J. Chris Fleming, Thomas C. Naugle
Surgical technique: The anterior lacrimal crest is identified. The sharp tip of the NKD is placed at the junction of the caruncle and conjunctiva within the lacrimal groove and pushed infero-medially at a 45-degree angle (Figure 2a) to penetrate through conjunctiva to the nasal mucosa, creating an osteotomy from the external conjunctiva into the middle meatus. Using nasal endoscopy or illuminated speculum, the tip of the NKD can be observed entering the nasal cavity, confirming optimal tract placement. If the middle turbinate obstructs the tract, a middle partial turbinectomy can be performed.13,14 Takahashi forceps can be used to remove any bone fragments created by the NKD that obstruct the osteotomy or impede placement of the Jones tube.
Nasal floor augmentation for empty nose syndrome
Published in Acta Oto-Laryngologica Case Reports, 2022
Munetaka Ushio, Junko Ishimaru, Sayaka Omura, Yasushi Ohta, Mitsuya Suzuki
The reported influence of inferior turbinectomy on negative symptoms is variable. Courtiss et al. reported that 20% of the cases do not show an improvement and 8% show worsening even after inferior turbinectomy, and 8% of cases show dryness of the nasal cavity [9]. Similarly, Passali et al. reported that the symptoms of atrophic rhinitis appear in 22% of cases following inferior turbinectomy [1]. In contrast, Ophir et al. reported that symptoms do not appear during long-term observation following inferior rhinoplasty [10]. However, Hong et al. reported that a decrease in the size of the residual inferior nasal turbinate was associated with an increase in the severity of symptoms such as nasal dryness and facial pain [11].