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