Coblation conchotomy (synonyms: turbinate reduction, turbinate reduction; English : turbinectomy) is a minimally invasive surgical procedure for the (surgical) reduction of enlarged turbinates (conchae nasales). It is used as a therapeutic measure in the treatment of altered turbinates that impair breathing. The so-called coblation (“controlled ablation”; “cold ablation”; synonyms: radiofrequency surgery, radiofrequency therapy) is a technical procedure for gentle tissue ablation. The coblation procedure uses bipolar radiofrequency energy to remove soft tissue in a targeted manner without damaging surrounding healthy tissue by developing high temperatures. Coblation is thus suitable for the gentle performance of a conchotomy.
Indications (areas of application)
- Anatomical variants of the nasal turbinates.
- Chronic nasal dysfunction – with reflex compensatory hyperplasia of the tissue (excessive growth).
- Hyperreflective rhinitis or vasomotor rhinopathy – severe watery secretion of the nasal mucosa due to a dysfunction triggered by external or internal factors.
- Mucosal hyperplasia – excess of nasal mucosa.
- Septum deviation (nasal septum curvature) with reflex compensatory hyperplasia of the tissue.
- Trauma (injury) to the turbinates with reflexive, compensatory hyperplasia of the tissue.
- Enlargement of the bony portion of the turbinates.
- Soft tissue changes, which can be, for example, chronic, drug-induced or hormonal.
Contraindications
If an infection is present, a conchotomy should not be performed under any circumstances. In particular, symptoms in the ear, nose and throat area such as rhinitis should be considered absolute contraindications.
Before surgery
Before the procedure, the patient must be informed of the risks of the surgery and give written consent. Discontinuation of anticoagulants (blood-thinning medications) such as acetylsalicylic acid (ASA) or Marcumar should also be done in consultation with the attending physician. Suspending medication for a short period of time significantly minimizes the risk of rebleeding without a significant increase in risk to the patient. Furthermore, the patient should be advised of any disturbances in wound healing that may be related to nicotine use.
The procedure
The procedure is performed on an outpatient basis and is of short duration (10 min). It is usually performed under local anesthesia (local anesthetic). During coblation as part of conchotomy, special disposable probes are used through which bipolar radiofrequency energy can be applied to the tissue. Parallel to the removal of the tissue, the surgical area is flushed with saline solution. In this process, the electrolytes (saline solution) are stimulated to form a so-called plasma field using radiofrequency energy in a conductive medium. This consists of ionized particles whose energy can be used to break down organic molecular bonds. The targeted administration of saline solution into the surgical area forms the basis for the generation of the plasma field, in which the saline solution serves as a conductive medium. The plasma field can break cell contacts, resulting in molecular disruption of the target tissue. The hyperplastic areas of the turbinates can thus be effectively removed. Unlike radiofrequency-induced thermotherapy, the temperature of the tissue is only raised to about 50-70 °C. This makes coblation a very effective procedure. On the basis of this, coblation is a gentle procedure.
After the operation
Postoperative cooling of the nose is recommended, as this can reduce swelling and possibly postoperative bleeding. Following the procedure, the patient can go home. Improvement in nasal breathing occurs within a week. Scientific studies show that an approximate 50% improvement in nasal breathing occurs within one week. Patients report long-lasting relief after 3, 6, and 12 months.
Potential complications
- Post-bleeding
- Wound infections
- Postoperative respiratory infections
- Headaches
- Pain in the surgical area
- Empty Nose Syndrome (ENS) (Synonyms: Empty Nose Syndrome, also “Open Nose”) – This syndrome involves increased dryness in the nasal area, which can result from the removal of conchal tissue. As a result, many patients also have crusting and suffer from shortness of breath. This seems paradoxical, since after turbinate reduction there is more space for air to flow in and out. The turbinates themselves serve to humidify the nose (air conditioning), so an increased removal of this tissue leads to the fact that the turbinates can no longer perform their task and thus the nose dries out.
- Ozaena (stinky nose) – In very rare cases, after surgery, there may be the formation of the so-called stinky nose, which is characterized by the fact that it becomes clogged with dry crusts that are colonized by bacteria. Despite this relatively serious complication, there is a possibility of healing within a short time, because the mucous membrane of the turbinates is very capable of regeneration.
