Hypertrophic Turbinates:  Prevalence, Surgical Indications and Outcomes in Orthognathic Surgery Patients

Thursday, September 13, 2012: 2:50 PM
Reza Movahed DMD Dallas, TX, USA
Will Allen DMD Dallas, TX, USA
Carlos Morales-Ryan DDS Dallas, TX, USA
Larry Wolford DMD Dallas, TX, USA
Movahed R, Allen W, Morales-Ryan CA, Wolford LM.

Purpose: Evaluate the prevalence of hypertrophic turbinates in orthognathic surgery patients; establish a possible trend for specific patient skeletal profile; and report outcomes of partial turbinectomies and LeFort I osteotomy.

Patients and Methods: Records of 591 consecutive patients who had maxillary orthognathic surgery from a single private practice were retrospectively evaluated. Diagnostic criteria for hypertrophic turbinates included: 1)history of consistent difficult breathing through nasal airway; 2) clinical and radiographic evidence of the turbinates blocking the majority of the nasal airway; 3;)predominantly mouth-breathing particularly when sleeping. Evaluations included: Medical history; clinical assessment; standardized x-rays (lateral cephalogram, orthopantomogram, Waters view); A-P, vertical position, transverse dimension of the maxilla and mandible, and occlusal plane angulation as determined from lateral cephalograms and dental models; External and internal nasal deformities; and current respiratory problems. Surgical outcomes and complications were recorded. Descriptive statistics and Pearson's Correlation Analysis were utilized to evaluate the results.

Results: Hypertrophic turbinates were present in 236 of 591 patients (39.9%). All 236 patients presented with moderate to severe hypertrophic turbinates and partial nasal airway obstruction. Sex distribution was 136 females (57.6%) and 100 males (42.4%). Mean age was 28 years (13 to 58). Bilateral partial inferior nasal turbinectomies were performed simultaneously with LeFort I osteotomies, resecting 2/3 to 3/4 of each turbinate. Surgical sites were cauterized. In addition, 60 patients (25.4%) had external rhinoplasty and 159 patients (67%) had nasal septoplasty. The occurrence rates of hypertrophic turbinates relative to deformity type were: 1) maxillary hypoplasia A-P (82.2%), vertical (45.3%) and transverse (52.5%); 2)mandible hypoplasia A-P (70.3%), normal vertical (94.9%) and normal transverse (97.9%) and 3)high occlusal plane angle (60.2%). A skeletal profile was identified: Maxillary and mandibular A-P hypoplasia showed a strong correlation (R=0.95,p<0.05); and high occlusal plane angle showed a moderate to strong correlation (R>0.81;p<0.05). All patients reported improved breathing at longest follow-up. The most common postoperative sequelae was mild increased bleeding from the turbinate surgical sites immediately post-surgery as compared to orthognathic patients without turbinectomies. No other known complications occurred.

Occurrence of Hypertrophic Turbinates Relative to Type of Dentofacial Deformity

Group

                  Maxilla

               Mandible

   Occlusal Plane

       A-P

    Vertical

    Transverse

      A-P

   Vertical

    Transverse

Normal

16.1%

19.5%

44.9%

10.2%

94.9%

97.9%

Normal

35.2%

Hypoplasia

 82.2%

45.3%

52.5%

70.3%

2.5%

0.8%

Low

4.7%

Hyperplasia

1.7%

35.2%

2.5%

19.5%

2.5%

1.3%

High

60.2%

Conclusions: Careful presurgical evaluation, not only of the skeletal deformity, but also of functional airway problems is important. In this study, there was a high prevalence of hypertrophic turbinates in patients with A-P hypoplastic maxilla and mandible with high occlusal plane angle. Partial inferior turbinectomies is a safe and predictable procedure that can be easily performed in conjunction with LeFort I osteotomies.

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2. Sapci T, Sahin B, Karavus A, Akbulut UG. Comparison of the Effects of Radiofrequency Tissue Ablation, CO2 Laser Ablation, and Partial Turbinectomy Applications on Nasal Mucociliary Functions. Laryngoscope 113: March, 514, 2003

3. Nurse LA, Duncavage JA. Surgery of the Inferior and Middle Turbinates. Otolaryngol Clin N Am 42: 239, 2009