Rebuilding the inferior turbinate with hydroxyapatite cement

Ear, Nose & Throat Journal, April, 2000 by Dale H. Rice

Abstract

This article describes a method of reconstructing a totally resected inferior turbinate with hydroxyapatite cement in patients who experience symptoms often associated with an overzealous resection of the turbinate (the "empty nose" syndrome).

Introduction

Most head and neck surgeons are quite familiar with the complaints of patients who have undergone an overzealous resection of the inferior turbinates coupled with septoplasty for nasal obstruction. In 1997, Moore et al reported that half of the 222 patients in their series complained of persistent nasal obstruction despite the presence of a large airway. [1] All 222 patients complained of crusting and dryness, and half experienced associated chronic rhinosinusitis. To describe this situation, Moore et al coined the term "empty nose." This article describes one possible method of reconstructing a totally resected inferior turbinate.

Case report

A 42-year-old woman came to the otolaryngology department for an examination. She had undergone two previous operations for nasal obstruction and chronic sinusitis, both on the left side. At the time of her examination, she complained of paradoxical airway obstruction, dryness, crusting, and chronic sinusitis.

Her nasal examination was remarkable for a small amount of mucopurulent drainage from the middle meatus and a complete absence of the inferior turbinate on the left side (figure 1). After a long discussion, the physician and patient decided that she would undergo endoscopic sinus surgery and an attempt to reconstruct the inferior turbinate with hydroxyapatite cement.

The reconstruction of the inferior turbinate was accomplished by making an incision on the lateral nasal wall from the attachment of the inferior turbinate inferiorly. A subperiosteal tunnel was carefully fashioned along the entire anterior-posterior length of the nasal cavity. Following this, the hydroxyapatite cement was mixed slightly wetter than is normally the case and injected through a large syringe with an attached large-bore catheter to fill the subperiosteal pocket. After the material was held in place for a few moments, it tended to remain in place without additional effort. The remainder of the procedure was accomplished in the usual manner.

Three months later, the patient had a stable, well-formed inferior turbinate (figure 2), which was still maintained 1 year after the procedure.

Discussion

The author has performed similar reconstructions in other patients with Gortex and with AlloDerm, and all have healed without incident and with little loss of volume over 6 to 12 months of followup. Whether these materials maintain their volume over a longer period of time remains to be seen. The potential for adverse effects such as infection or rejection also remains uncertain at this time.

From the Department of Otolaryngology-Head and Neck Surgery, University of Southern California School of Medicine, Los Angeles.

Reference

(1.) Moore ES, Reder PA, Kern EB. Atrophic rhinitis: A review of 222 cases. Presented at the American Rhinologic Society meeting; May 1997; Scottsdale, Ariz.