Laser conchotomy (synonyms: laser turbinate reduction, laser turbinate reduction, laser turbinate reduction) is a surgical procedure to reduce an enlarged turbinate using a special laser. A turbinate reduction (reduction of the size of the turbinate) is usually necessary when hyperplasia (proliferation of cells) leads to a reduction in the circumference of the airways in the nose as an adaptation reaction, so that adequate ventilation through the nose is no longer possible. The causes of enlargement of the conchae nasales (nasal concha) can be varied. However, of particular importance is a chronic infection in the conchal area, which as a consequence leads to enlargement of the conch. Due to the permanent inflammation, the tissue structure changes. Parallel to this, the volume of the mussel increases, so that the airways are reduced in size. Acute infection also generally results in an increase in tissue volume, as edema (accumulation of fluid) may temporarily occur due to inflammation. The basic principle of laser conchotomy is based on the use of a diode laser. With the help of this laser it is possible to perform a reduction of the hyperplastic conchae nasales and thus facilitate ventilation. The used wavelength of the diode laser is in the range of 980 nm and thus in the infrared range. If one compares the performance of a conventional conchotomy, which is performed without laser cutting, with a laser conchotomy, it becomes clear that a significant reduction in pain can be achieved through the use of the laser, which has been proven in clinical studies. Furthermore, bleeding complications also occur less frequently with the aid of the laser, as the laser beam directly obliterates damaged blood vessels. Thus, the risk of secondary bleeding is also significantly reduced and there is no need for postoperative (after surgery) tamponade of the nose. In addition, the procedure is a gentler method compared with conventional conchotomy, which means that the patient’s recovery time after the procedure is relatively short.
Indications (areas of application)
- Mucosal hyperplasia – an excess of turbinate mucosa may result in the patient’s inability to breathe adequately through the nose.
- Trauma – Injury to the turbinates with reflex compensatory hyperplasia of the tissue. However, surgical reconstruction of the nose may be necessary to permanently prevent hyperplasia.
Contraindications
If an acute infection is present, laser conchotomy should not be performed under any circumstances. In particular, ear, nose, and throat symptoms such as rhinitis should be considered absolute contraindications.
Before surgery
- Anesthesia – unlike conventional conchotomy, laser conchotomy does not require general anesthesia. However, at the patient’s request, general anesthesia is performed instead of local anesthesia. Here it should be noted that the patient should be physically able to compensate.
- Anticoagulation – although laser conchotomy has a low risk of post-operative bleeding due to the obliteration of blood vessels parallel to the incision, it is still necessary to discontinue anticoagulants (anti-bleeding medications) such as Marcumar or acetylsalicylic acid (ASA) a few days before the surgical procedure. Discontinuing medication for a short period of time significantly minimizes the risk of secondary bleeding without a significant increase in risk to the patient. If diseases are present that can influence the blood coagulation system and these are known to the patient, this must be communicated to the attending physician. If necessary, the presence of such a disease leads to the suspension of the therapeutic measure.
The surgical procedure
The performance of laser conchotomy as an additional alternative to conventional surgical conchotomy for the reduction of the conchae nasales has been gaining importance for several years, because of an improved complication profile and, furthermore, the results of the procedure are comparable to those of the conventional method. The procedure also represents a clear improvement for the treating physician because it is relatively easy to handle and the procedure can be performed on an outpatient basis.However, laser conchotomy represents a procedure that differs in treatment success depending on the material used. Of crucial importance for the treatment is the laser used. The carbon dioxide laser and the argon laser as well as the diode laser can be used for the procedure. With all of the listed laser variants, a significant improvement in subjective nasal breathing can be observed. In a clinical study it was shown that with the help of the argon laser a probability of success in the treatment of conchal hyperplasia of 80 percent can be achieved. As already described, the procedure is usually performed under local anesthesia (local anesthesia). Several cotton balls are placed in the nose for analgesia (painlessness). The placed cotton balls are previously mixed with a strong anesthetic and anti-swelling drug. For optimal effect, the medication must remain in the nose for approximately 30 minutes before the surgical intervention can begin. With the help of an analgesic (pain reliever), virtually no pain is noticeable during the procedure. Nevertheless, it should be noted that a slight pulling or burning sensation may be perceived in the nasal area if necessary. If, contrary to expectations, pain still occurs, there is the option of subsequently applying an additional dose of local anesthetic. The pain caused by the puncture can be compared to that experienced during anesthesia at the dentist.
After the operation
- Since nasal tamponades are not used after surgery, the use of special ointments and rinses is indispensable. The application of these preparations in the area of scarring even allowed histological (microscopic) evidence of regeneration of the respiratory epithelium after a few months.
- A control examination one day after surgery has been performed is very important for the exclusion of various complications and for the assessment of the course of the operation.
Possible complications
- Postoperative bleeding – although postoperative bleeding after laser conchotomy is much less common than with conventional conchotomy, the risk is still present. However, it is not necessary to use a nasal tamponade.
- Wound infections – even if in principle no scalpel is used, there is still a risk of infection.
- Postoperative respiratory infections
- Headaches
- Pain in the surgical area – during the procedure, the attending physician can administer a local anesthetic if needed to consistently relieve pain. However, pain may occur postoperatively, so taking an analgesic may be necessary. However, the additional local anesthetic will necessitate the placement of an injection, which increases the risk of injury to nerve fibers.
- Empty Nose Syndrome (ENS) (Synonyms: Empty Nose Syndrome, also called “Open Nose”) – This syndrome is an increased dryness in the nasal area, which can result from the removal of the 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, as the mucous membrane of the turbinates is very capable of regeneration.
