Coagulation of the nasal turbinates. Features of cauterization of nasal turbinates Nasal turbinates operation

Suggested large number surgical methods for the treatment of chronic rhinitis from primitive chemoacoustics (D.I.Zimont, 1940; A.H.Minkovsky, 1949 (before progressive laser destruction of the inferior turbinates (M.S. Pluzhnikov, 1997). The turbinates were exposed to cold and high temperatures, scalpel and ultrasound. Treatment methods for chronic rhinitis were combined (A.M. Svetleyshiy, 1981; S.B. Lopatin, 1998) and improved, pursuing the same goal: to give a person nasal breathing.

In general otorhinolaryngology, its use was highlighted by M.G. Leizerman (1998b 1999). The author applied the radiosurgical method in the treatment of ronchopathy, chronic hypertrophic pharyngitis, described the method of removing benign neoplasms mucous membranes and skin, used a radio knife to open paratonsillar abscesses, nasal boils, and nasal septum abscesses. M.G. Leizerman noted a significant reduction in operation time and a decrease in blood loss during tracheostomy, tonsillectomy, operations on the paranasal sinuses, on the middle ear, and when removing median and lateral neck cysts. He also described the first experience of using the radiosurgical device “Surgitron” in operations for laryngeal cancer.

We performed submucosal radiocoagulation of the inferior turbinates in patients with chronic rhinitis, of which 25 people suffered from allergic rhinitis, 30 from hypertrophic (cavernous form), and 32 from vasomotor rhinitis. The age of the patients ranged from 15 to 65 years.

The examination included, in addition to the usual ENT examination, endoscopic examination nasal cavity, anterior standard rhinomanometry, determination of mucociliary transport time, activity of absorption and excretory functions of the nasal mucosa, microbiological examination nasal secretion, counting the number of eosinophils in nasal secretion, its cytological examination, allergological examination of patients, computed tomography paranasal sinuses.

The group of patients did not include those patients who had previously undergone surgical methods treatments, for example, galvanocaustics, ultrasonic disintegration, laser destruction inferior nasal conchae, otherwise, due to changes in the tissue of the conchae, the results we obtained would not be accurate and objective.

The radiosurgical device "Surgitron" is a compact, portable device weighing 4 kg, with an adjustable output power of up to 140 W depending on the operating modes and the position of the power switch, with an output frequency of 3.8 MHz. For submucosal radiocoagulation of the inferior turbinates along the entire length, a bipolar probe has been developed, consisting of a pencil handle and bayonet-shaped needle electrodes for better visualization during surgery. Needles 4 cm long, located parallel at a distance of 3 mm from each other, are used for targeted destruction of tissue.

Technique for submucosal radiocoagulation of the inferior turbinates

The “coagulation” mode is selected, the power regulator is set between 3 and 4 units of the nine-digit scale, which corresponds to 30-35 W of output power. Before the operation, topical anesthesia of the mucous membrane of the inferior turbinate is performed with a 5% solution of cocaine or a 2% solution of dicaine. Then 3.0 ml of a 1% lidocaine solution or a 0.5% novocaine solution is injected into the thickness of the shell. After anesthesia, needle-electrodes are brought to the anterior end of the inferior turbinate, inserted along the entire length into the thickness of the nasal turbinate, and the supply of radio waves is activated using a foot pedal. Exposure is usually 6-10 seconds until the tissue visually fades. The needles are removed, after which the activation of the device stops. At the anterior end of the inferior turbinate, an area of ​​coagulative tissue necrosis is visually determined. The described intervention is performed on both hypertrophied inferior turbinates. The entire operation takes no more than 7 minutes, including anesthesia. Patients usually tolerate the procedure very easily, with some describing a slight burning sensation in the nose during the procedure. Others negative reactions we did not note.

We assessed the long-term results of treatment after 3, 6 and 12 months according to the following criteria:

• “Persistent improvement in nasal breathing” - patients stopped using and experiencing the need for vasoconstrictor drops.
• “Improved nasal breathing” - patients had to use vasoconstrictor drops at night.
• “No effect” - patients continued to use vasoconstrictor nasal drops.

The postoperative period was favorable for the patients. No complications were observed, the interventions were almost bloodless. Initial inflammatory phenomena - swelling and hyperemia of the nasal mucosa - occurred after 2-3 hours, reaching a maximum within 1 day. The inflammation subsided by the end of the first week.

In approximately 10% of cases, the patients had no swelling the next day, but in 90% of cases, the inferior turbinates looked swollen on the first day, and breathing was difficult. We did not observe the formation of crusts in the nose after this operation in any case. As a care for the nasal cavity postoperative period To quickly restore the function of the nasal mucosa, we recommended that after our operation, irrigation of the nasal cavity twice a day with warm saline solution - a nasal douche.

Treatment results

The group of patients with allergic chronic rhinitis consisted of 25 people. The allergic nature of chronic rhinitis was confirmed by positive allergological tests, the determination of a significant number of eosinophils in smears from the nasal mucosa, as well as an increased percentage of eosinophils in peripheral blood. A burdened hereditary history was identified in 18 patients (72%), 2 patients did not know about the allergic nature of their disease. All patients suffered year-round allergic rhinitis, they received positive tests on house dust, epidermal allergens, feather pillows, library dust. 8 patients also suffered from seasonal allergic rhinitis; they tested positive for pollen from trees, cereals and weeds. All patients were constantly forced to use vasoconstrictor drops and antihistamines.

During endoscopy of the nasal cavity, pastiness, pallor, and cyanosis of the mucous membrane were observed. In some cases, the inferior and middle turbinates were polypous.

The rate of mucociliary transport was sharply reduced to 58.2 ± 2.0 min. (compared to the control group - 31.3 ± 1.7 minutes), excretory function increased to 4.5 ± 1.1 minutes (in the control group - 8.12 ± 1.3 minutes). The suction function was practically absent.

The operation was carried out after preliminary preparation: reception antihistamines within 3-4 days before surgery. The patients were also explained the need to eliminate allergens, such as changing bedding, the need for only wet cleaning in the apartment, etc. In patients with concomitant seasonal allergic rhinitis, surgery was performed only during the period of remission. In the postoperative period, we observed persistent swelling of the mucous membrane of the inferior turbinates for approximately 4-6 days. During this period, patients were also prescribed antihistamines, was allowed local application vasoconstrictors. But within a week the first signs of improvement in nasal breathing appeared. So, if in this group of patients, when performing anterior standard rhinomanometry before surgery, the average total volume flow was 60.3 ± 1.2 ccm/s (in the control group - 682.6 ± 35.8 ccm/s), then a month after operation it already averaged 548.2 ± 31.6 ccm/s, which is 80.3% of normal breathing, according to these indicators, the resistance in the nasal cavity decreased.

Objective tests were modified according to the clinical picture. A significant decrease in eosinophils in reprint smears from the nasal mucosa was revealed, and the intensity of epithelial desquamation and neutrophil migration decreased. IN functional state ciliated epithelium showed a tendency to improve, i.e. Mucociliary transport was already about 40 minutes a month after surgery, excretory function was 5.9 ± 0.8 minutes. However, the absorption function was not completely normalized: weak staining of the nasal mucosa with the indicator remained.

Examination of patients after 3 months showed a “persistent improvement in nasal breathing” in 13 (52%) people (the patients stopped using vasoconstrictor drops or felt the need for them). “Improvement” occurred in 10 (40%) people (patients required vasoconstrictor drops only at night). In 2 (8%) patients, unfortunately, no effect was achieved (the patients continued to use vasoconstrictor drops). After 6 months, “persistent improvement in nasal breathing” remained in 10 of 21 patients (40%), “improvement” in 11 people (44%). After a year, “persistent improvement in nasal breathing” remained in 7 patients (29.2%), the “improvement” criterion applied to 12 patients (50%). Unfortunately, 5 patients (20.8%) met the “no effect” criterion. Contact with one patient was lost after a year.

The next group of patients consisted of patients suffering from vasomotor rhinitis. Their allergy tests were negative. In the reprint smears, single eosinophils were found in one or several fields of view. Moderate desquamation of the epithelium and migration of neutrophils were observed. The clinical picture of the disease was characterized by paroxysmal attacks, rhinorrhea, and sneezing. Of the 30 patients, 11 had one or another pathology thyroid gland, 25 had vegetative-vascular dystonia.

During endoscopy of the nasal cavity, a pasty, pink-bluish color of the mucous membrane of the nasal cavity was observed, in some patients - characteristic Vojacek spots - an indicator vascular dystonia. In this group of patients we obtained the best results.

In 28 (93.3%) patients, the reflex mechanism of contraction of the inferior turbinates “triggered” immediately after the operation. That is, patients immediately after surgery felt improved nasal breathing. Two weeks after surgery, all 30 patients stopped using vasoconstrictor drops. Our objective tests were consistent with the clinical picture. 3 months after surgery, nasal breathing significantly improved from 150.4 ± 9.8 ccm/s before surgery to 640.2 ± 22.6 ccm/s (p< 0,01), время мукоцилиарного транспорта сократилось от 51,3 ± 0,3 минут до 33,4 ± 0,5 минут, выделительная и всасывательная функции нормализовались.

After 3 months, we observed “persistent improvement in nasal breathing” in 90% of cases, i.e. in 27 people, 3 (10%) patients experienced “improved nasal breathing.” After 6 months, “persistent improvement in nasal breathing” remained in 25 (83.3%) people, 3 (10%) people needed vasoconstrictor drops at night - the “improvement” criterion. After 1 year, 20 (69%) people had “persistent improvement in nasal breathing”, 8 (27.6%) had “improvement...”. Unfortunately, 1 (3.4%) person was again forced to use vasoconstrictor drops a year later, but fewer of them than before the operation - the “no effect” criterion; another patient dropped out of the study due to a change of place of residence.

The third group consisted of 20 patients with chronic hypertrophic rhinitis, predominantly cavernous form. Clinically, all patients with chronic hypertrophic rhinitis noted frequent colds. Patients in this group used vasoconstrictor drops the longest: on average about 15 years. During rhinoscopy, we noted a characteristic appearance of the mucous membrane: congestive hyperemia of the nasal turbinates, varying from deep red to plum-red, sharp, mostly diffuse hypertrophy.

We did not find eosinophils in reprint smears from the nasal mucosa, but noted a significant intensity of neutrophil migration and epithelial desquamation, which characterizes a sluggish, inflammatory process.

In general, in the group of patients with chronic hypertrophic rhinitis, we also obtained satisfactory results. Of the 32 people, after 3 days breathing returned to normal in 10 people (31.2%). After 2 weeks, clinically, all patients experienced contraction of the inferior turbinates. Objective indicators also changed accordingly. If before the operation the average total volume flow was 104.5 ± 7.4 ccm/s, then one month after the operation the average total volume flow was already 672.2 ± 31.4 ccm/s (p< 0,01). Нормализовалось и состояние слизистой оболочки полости носа. Если до операции в мазках-перепечатках со слизистой оболочки носа определялась выраженная десквамация epithelial cells and intensive migration of neutrophil leukocytes to its surface, then a month later we saw a different picture: the eviction of neutrophil leukocytes stabilized, having the character of a weakly expressed migration, the degree of desquamation of the epithelium decreased. Laboratory tests were confirmed by the clinical picture. During endoscopy of the nasal cavity, the mucous membrane acquired uniform pink, congestive hyperemia went away.

After 3 months, we observed “persistent improvement in nasal breathing” in 30 people (93.7%), “improvement” in 1 (3.1%) person, the criterion “no effect” was in 1 patient (3.1%) . After 6 months, 25 (78.1%) people did not use vasoconstrictor drops, 5 (15.6%) patients had a need to use vasoconstrictor drops at night, 2 (6.3%) continued to use decongestants in the nose. After a year, the criterion of “persistent improvement in nasal breathing” was applicable to 20 patients (66.7%), “improvement in nasal breathing” was observed in 8 people (25%), “without effect” - in 4 people (12.5%).

For clarity, we present all follow-up results in Table 1.

Table 1.

Long-term results of treatment of patients various forms chronic rhinitis.

Chronic form rhinitis	Number of people	3 months			6 months			Number of people	12 months
Allergic
Vasomotor
Hypertrophic
TOTAL:

S.V. Ryabova, B.V. Starosvetsky candidate. medical sciences

G.Z.Piskunov professor dr. medical sciences

Course of otorhinolaryngology UC MC UD of the President of the Russian Federation,

Polyclinic No. 1, Department of the President of the Russian Federation, City Clinical Hospital No. 71, Moscow

In: Russian Rhinology, No. 1, 2000, pp. 26-27

When the nose does not breathe due to vasomotor rhinitis or a number of other reasons, patients are often prescribed turbinate vasotomy.

This operation is designed to improve blood supply and permanently solve the problem of nasal breathing problems.

Today, there are several techniques for performing this type of surgery. They all have their own characteristics, advantages and disadvantages, therefore, when choosing specific way, you must first of all listen to the opinion of the surgeon, who will certainly take into account all the wishes of the patient.

Nasal vasotomy: what is it? Indications for surgery

Vasotomy is a surgical treatment method chronic diseases nose, which involves the destruction of the vessels of the nasal concha in one way or another, due to which their volume decreases.

During the operation, doctors peel off the mucous membrane and eliminate vascular (venous) bundles that cause deterioration in the patency of the air stream.

The inferior turbinates themselves are small bony protrusions located on the lateral surfaces of the nostrils.

They are covered with a mucous membrane with a pronounced submucosal layer, which is responsible for humidifying and heating the air inhaled by a person.

But in a number of diseases, swelling and hypertrophy of the nasal concha occurs due to increased blood supply to numerous vessels of the submucosal layer.

This provokes a narrowing of the passages and a deterioration in the air flow during inhalation, up to its complete impossibility.


It is in such situations, when prolonged conservative therapy did not bear fruit, submucosal vasotomy of the inferior turbinate is indicated. As a rule, it is performed when:

• vasomotor, including
• chronic runny nose;
• endocrine pathologies that provoke hypertrophy of the nasal turbinates.

The procedure can also be prescribed for children if indicated. Depending on whether both halves of the nose are affected or only one, bilateral or unilateral vasotomy can be performed.

Contraindications to turbinate vasotomy

For many patients, the only way to restore normal breathing is vasotomy; the operation has few contraindications, however, if they are present, it cannot be prescribed. It's about O:

• any acute infectious diseases;
• purulent processes in paranasal sinuses ears, ears and other parts of the ENT organs;
• exacerbation of chronic pathologies;
• blood diseases.

Source: website If the patient is diagnosed chronic sinusitis, before vasotomy or simultaneously with it, maxillary sinusotomy can be performed.

What tests are taken for vasotomy? Preparing for surgery

Before the procedure, patients need to confirm the need for surgery and identify possible concomitant pathologies. Therefore, patients need:

• take blood tests;
• (endoscopic examination of the nasal cavity);
• Ultrasound of the paranasal sinuses (echosinusoscopy);
• sometimes CT or MRI.

2 weeks before the appointed date, and also stop taking anticoagulants (including Aspirin, Phenilin, etc.), if they were prescribed by other specialists to eliminate or prevent certain disorders.

Types of vasotomy: how is the operation performed?

There are several techniques for reducing the volume of the nasal turbinates. The otolaryngologist decides which one is best for the patient based on the nature of the current disease, individual characteristics patient, age, etc.


Each method has pros and cons, so it is impossible to say for sure which one is the best.

Nevertheless

IN lately classical surgical interventions are becoming a thing of the past, giving way to modern minimally invasive manipulations.

Instrumental

Open surgery- This is a traditional method for eliminating shell hypertrophy. Depending on the situation, the doctor may suggest treatment using one of the following techniques:

Submucosa. The essence of the method is to separate the mucous membrane and destroy the submucosal vascular plexuses with a scalpel.

Lateralization (lateropexy). This technique involves breaking and displacing the concha to the wall of the nostril and securing it in a new position, which allows you to increase the diameter of the passage and make room for a stream of inhaled air.

Vasoconchotomy (conchoplasty)– resection of part of the nasal concha and the mucous membrane covering it.

As a rule, nasal vasotomy is performed with sedation, that is, during the procedure the patient remains conscious, is able to communicate and follow the surgeon’s commands, but does not feel pain and is inhibited due to the administration of strong sedatives. Less commonly, the procedure is performed under local or general anesthesia.


After it, the patient remains in the hospital, the duration of his stay depends on the severity of the postoperative period and the presence of complications. In any case, the procedure takes no more than 5–15 minutes.

Do blood vessels recover over time after vasotomy? Usually not, since scar tissue remains in their place, which prevents relapse.

Turbinoplasty

The method is used in severe cases and consists of removing part of the nasal concha through a small incision, although the mucous membrane is preserved.

Highly undesirable complete removal these anatomical structures, since this can lead to the development of undesirable consequences, in particular, the inability to breathe through the nose, although objective reasons there will be no more such violation.

Attention

Among all methods of surgical intervention, turbinoplasty is considered the most effective.

This operation on the nasal turbinates gives the most pronounced and lasting effect, but since it is quite traumatic, complications often arise after it.

Shaver destruction or microdebrider conchotomy

The method is classified as surgical. Its use makes it possible to perform both turbinoplasty or conchotomy, and submucosal vasotomy.

The main difference between it and the classical operation is the use of a special tool - a shaver. It is a kind of electric knife: a rotating blade connected to an electric suction device, so when applied, all cut tissue is immediately removed from the surgical field.

Laser vasotomy of the nasal turbinates

This method is one of the most popular because it is characterized by low cost, low level of trauma and high efficiency. When removing venous plexuses with a laser, a light guide is inserted into the nasal turbinate, and the energy of the beam provokes evaporation of the tissue.


After the procedure, breathing usually recovers quite quickly, and the risk of relapse is low. At the same time undesirable consequences are rarely observed.

Radio wave disintegration of the inferior turbinates

This is one of the most modern minimally invasive methods for eliminating pathologically altered tissues and neoplasms. It involves inserting a probe under the mucous membrane that produces radio waves.

They force cells to actively oscillate, which leads to an increase in temperature to high values, coagulation of blood vessels and normalization of the size of the nasal turbinates. The method is often called radio wave destruction, conchotomy or reduction.

Coblation

Coblation vasotomy (cold plasma or molecular quantum reduction) involves the creation around surgical instrument fields of cold plasma, which leads to the appearance of ions of a certain kind, provoking the breaking of bonds between molecules. It is one of the methods of radio wave surgery.

When using coblation, tissues are heated only to 40–70 °C. This allows you to solve existing problems with minimal damage to surrounding structures.

Ultrasonic disintegration

The destruction of the submucosal layer occurs due to the influence of ultrasonic waves. They provoke gluing of the walls of the affected vessels.

Typically, the procedure is prescribed for mild forms of hyperplasia, that is, when the inferior turbinate or both only slightly increase in volume. In other situations, there is a significant likelihood of relapse of the disease.

Vacuum resection

This one is relatively new method Today it is just being implemented in medical practice. Therefore, it is too early to talk about its effectiveness and safety.

Its essence is the aspiration of cells of the submucosal layer with a special pump instrument by creating negative pressure.

In general, vacuum resection is promising direction in otolaryngology and, perhaps, in the future will be no less popular than radio wave or laser disintegration.

Cryodestruction of the nasal turbinates

The essence of cryodestruction is the treatment of the mucous membrane with a cryoprobe at an extremely low temperature. As a result, large ice crystals form in the cells, which destroy the cell membranes.

The procedure causes thrombosis of the capillaries at the site of exposure, as a result of which they become bleeding and the swelling goes away.

Electrocautery

This method involves the destruction of vascular bundles by constant electric shock. Cauterization occurs by touching the affected areas with a hot electrode.

The procedure causes the tissue to scar, which leads to compression of the venous plexuses and, accordingly, a decrease in the volume of the nasal turbinates, while instant coagulation (sealing) of the vessels occurs, so the manipulation is not accompanied by bleeding. Sometimes it is also called electrocaustics or galvanocaustics.

Today, electrocautery is used less and less, as it is considered obsolete. There are many other methods that provide a more pronounced effect with less damage to healthy tissue.

Septoplasty and vasotomy

Both procedures are often combined, since congenital or acquired as a result of trauma (more often in men) septal deformations can also contribute to breathing problems.

Septoplasty implies that it is carried out by removing the protruding part cartilage tissue or bone crest.


This endoscopic surgery, therefore its implementation is associated with minimal damage to anatomical structures, which causes short rehabilitation period. Both procedures are indicated for patients who have

Price

The cost of vasotomy depends on the type of technique used, rating medical institution, its territorial location and the experience of the doctor.

In otolaryngology departments, classical surgical intervention can be performed absolutely free, but in private clinics in Moscow and St. Petersburg, eliminating hypertrophy with a laser or the Surgitron device (radio wave disintegration) can cost from 3,000 to 30,000 rubles.

Rehabilitation after septoplasty and vasotomy

Usually recovery occurs quite quickly. The duration of the rehabilitation period depends on the method of surgery, and patients often receive sick leave for the entire recovery period.

After classical operations, the nose is swabbed several times. The tampons are finally removed only after dense crusts have formed.


If the surgical intervention was as gentle as possible, that is, techniques such as laser, radio wave, ultrasound disintegration, etc. were used, the patient can leave the clinic already half an hour after the end of the manipulation. In any case, during the postoperative period it is prohibited:

• visit the bathhouse, sauna, swimming pools, gym;
• lift heavy objects;
• run;
• drink alcohol.

Patients need to carefully care for their nose after any type of vasotomy and strictly follow the recommendations received from their ENT specialist.

Experts usually recommend rinsing several times a day. saline solutions(Aquamaris, Physiomer, Marimer, No-sol, Dolphin, Aqualor, Salin, saline solution) and treat the mucous membranes with neutral oil, for example, vaseline, peach, sea buckthorn.

After surgery, antibiotics are often prescribed to prevent infection. wide range actions. If necessary, patients can take painkillers to relieve pain.

Possible complications after surgery

After the procedure, swelling, thick snot and crusts are almost always observed. When using a laser, radioknife or similar minimally invasive techniques, the condition normalizes in about 3–5 days, but after surgery - only after 1–1.5 months.

This explains the fact why, after a vasotomy, the nose cannot breathe again or the sense of smell has disappeared. For the final restoration of normal functioning of the nose time is required for tissue healing, swelling elimination, etc., although sometimes patients in such cases require repeated surgery.
Most likely complication An infection may become attached, this can be suspected by an increase in body temperature, and also if the runny nose gets worse, no matter what. Atrophy of the mucous membrane is also sometimes observed, which is accompanied by dryness and discomfort.

Radio wave coagulation of the inferior turbinates using the radiosurgical apparatus “SURGITRON” (USA)

The ENT doctor uses the "Surgitron" device for persistent difficulty in nasal breathing, as well as in the absence of effect from vasoconstrictor nasal drops, for diseases such as chronic hypertrophic rhinitis, as well as for (ronchopathy).

Using the Surgitron device, developed by American scientists at the Elman company, the ENT doctor performs an operation - radio wave coagulation of the inferior turbinates. This medical ENT manipulation is minor surgery, one of the advantages of which is the ability to operate on the patient’s ENT without hospitalization (outpatient), and a short period of rehabilitation and recovery after surgery, due to the less pronounced swelling of the mucous membrane of the lower nasal conchas, as with other similar operations: ultrasonic disintegration, laser coagulation, argon- plasma coagulation, cold plasma coagulation, cryotherapy and galvanocaustics of the inferior turbinates, allows us to safely give it preference and put it in first place, compared to the surgical methods of treatment listed above.

This ENT operation takes no more than 1 hour, and most of the time is spent on “preparation,” i.e. anesthesia. First, the ENT doctor performs local application anesthesia by placing a cotton swab moistened with a 10% lidocaine solution into the nasal cavity. Then the ENT doctor performs local infiltration anesthesia, making injections (injections) of Ultracaine DS-Forte into the thickness of the inferior nasal turbinates.

For high-quality and adequate pain relief, it is recommended to perform two injections into each lower turbinate. The ENT doctor performs the first injection insulin syringe with a small and thin needle. At the same time, the ENT patient practically does not feel the injection of the needle, but may feel slight tissue tension due to the “expansion” of the drug in the anterior sections of the inferior turbinate.

The effect of the drug Ultracaine DS-Forte is immediate, and the effect of anesthesia lasts about 3 - 4 hours, which makes it possible to guarantee an ENT patient’s operation with high-quality pain relief and enable the ENT patient to get home while under the influence of anesthesia.

The patient does not feel the second injection of Ultracaine DS-fortelor, since it is essentially conduction anesthesia, through the front in posterior sections inferior nasal concha. Then the ENT doctor gives the ENT patient the opportunity to get ready for the operation, while the action medicines are gaining full strength.

The ENT doctor performs radio wave coagulation of the inferior turbinates by introducing an electrode into the thickness of the inferior turbinate for 10 - 20 seconds, depending on the severity of the chronic process.

Another important advantage of this ENT operation is the 100% sterility of this method. This is achieved due to the fact that when you press the pedal and apply a radio wave to the electrode, within 1 mile second everything living (bacteria, fungi, viruses, vibrios, spirochetes, protozoa and other microorganisms) that is on the metal spokes of the electrode, the so-called working surfaces die, unable to withstand ultra-high temperatures. At the same time, it is important that the ENT patient does not have a cold and does not suffer from diseases such as acute respiratory infections, acute respiratory viral infections, sinusitis, pharyngitis, tonsillitis, laryngitis, bronchitis, tracheitis, pneumonia and other acute and chronic bronchopulmonary diseases at the time of the operation. This guarantees the ENT patient the “sterility” of this ENT operation.

With direct radio wave exposure, the patient either does not feel anything or feels a slight, but very tolerable burning or tingling sensation in the nose. Due to the high speed of radio wave exposure, all negative sensations of the patient’s ENT are minimized.

Another great advantage is the so-called controllability of this ENT operation, since the ENT doctor has the ability to set the required frequency of exposure. In fact, this is the force of the radio wave on tissue human body. Also, the ENT doctor has the opportunity to adjust the exposure at his own discretion, i.e. duration of exposure.

The most important and useful condition is that the ENT doctor has the ability to suspend the course of the ENT operation at any time or stop it altogether. Unfortunately, today this is not possible with all operations, including those on ENT organs.

After ENT surgery on the lower turbinates, the ENT doctor places cotton swabs in the nasal passages in order to avoid possible bleeding and prevent the development of severe swelling of the operated mucous membrane of the nasal cavity.

The ENT patient removes cotton swabs independently next morning after the operation, or can contact the ENT clinic where the operation was performed. 10 - 15 minutes after removing the tampons, it develops postoperative edema tissues of the inferior turbinates, and nasal mucosa.

Nasal breathing The patient's ENT will not be comfortable for 3 - 4 days after the operation, then the swelling of the nasal mucosa will gradually decrease, and nasal breathing will be restored.

Another important point postoperative course is the formation of “crusts” that complicate and interfere with nasal breathing. The so-called “crusts”, or if correctly, fibrinous-necrotic plaque, are formed 3-4 days after the operation, as a protective layer covering the operated area. At the same time, the nasal cavity needs careful toileting (cleaning), since this plaque tends to glue the mucous membrane of the operated inferior turbinate with the mucous membrane of the nasal septum. In this way, synechiae (adhesions) can form, which in turn will also need to be dissected, preventing the possibility of developing an adhesive process.

An ENT doctor performs a nasal toilet every day or every other day, but only in an ENT clinic sterile instruments. An ENT patient will not be able to remove “crusts” from the nose on his own due to their deep location and high adhesive ability. On average, an ENT patient comes to the ENT clinic after surgery for a nasal toilet 3 - 4 times. It all depends on the mechanisms of regeneration and the reproductive ability of the human body.

It is possible to reliably assess the effect and quality of the ENT surgery performed only after a month, since only by this time the mucous membrane of the lower turbinates will be completely restored.

The restrictions after this ENT operation are as follows:

complete failure from vasoconstrictor drops into the nose, since the nose will be able to breathe on its own,

restriction of physical activity (fitness, gym) for 2 - 3 weeks, restriction of baths, saunas for up to 1 month, restriction in use alcoholic drinks up to 2 - 3 weeks,

limitation sexual relations up to 2 - 3 weeks,

restriction in very hot foods, as well as spicy, salty, peppery, fried foods for up to 3 - 4 weeks.

In the first 14 days after surgery, a calm and measured rhythm of life is recommended, no emotional stress, no overwork. Desensitizing (decongestant) therapy and oily nasal drops are recommended.

Radio wave coagulation of the inferior turbinates is intended for patients who cannot breathe without the use of vasoconstrictors and who have pathological processes in the nasal passages caused by vascular dysfunction.

History of the origin of radio wave submucosal vasotomy of the inferior turbinates

Radiofrequency (radio wave) vasotomy

According to historical data, it is known that radio wave surgical methods for treating patients first appeared at the beginning of the twentieth century.

The first high-frequency radio wave device was created by Bovey in 1926. Essentially, the treatment consisted of inserting a probe under the mucous membrane of the nasal passages, which, when connected to the network, emitted waves with alternating current.

Thanks to them, the fabric was subject to heating and subsequently destruction. Vascular network decreased, the submucosal layer became empty and became smaller in volume. During this treatment, the nasal passages enlarged and breathing was restored.

In radio wave coagulation of the inferior turbinates, the tissues of the turbinates heat up and die under the influence of resistance to the radio wave.

What is radio wave coagulation of the inferior turbinates?

When visiting an ENT doctor with complaints of a lack of normal breathing, the specialist, after conducting an examination, may suggest this particular method of surgical intervention. Its specificity lies in the use of a specialized radio wave apparatus. Under its influence, evaporation occurs excess liquid in the mucous membrane of the nasal turbinates.

Radio frequency (radio wave) generator for vasotomy

Radio waves act locally, in the area where they are used. They heat the tissue, causing the destruction of the vascular network.

This type of surgery is painless. Radio wave submucosal vasotomy of the inferior turbinates is performed on an outpatient basis. The procedure itself takes no more than ten minutes.

The cost of radio wave reduction (vasotomy) of the nasal turbinates ranges from 10 - 12 thousand rubles.

Bipolar electrode for radio wave reduction of turbinates

Radio wave reduction of the inferior turbinates is a hardware type of surgical intervention; there are also inferior turbinates where a laser is used. The method and method of restoring breathing and expanding the nasal passages is chosen by an experienced specialist based on the patient’s medical history and based on the results diagnostic examination.

Indications and contraindications for radio wave reduction of the inferior turbinates

Indications for use radio wave vasotomy inferior turbinates:

1. Prolonged difficulty breathing
2. Often growing polyps in the nasal passages caused by disruption of the vascular network

Contraindications to the use of radioconchotomy in the treatment of inferior turbinates:

1. Diabetes mellitus at any stage
2. Malignant neoplasms
3. Acute respiratory disease in the acute stage
4. Presence of a pacemaker in the patient's body
5. Pregnancy throughout all three trimesters
6. Epileptic disease
7. Hepatitis
8. Cardiovascular failure

Progress of the operation of radio wave reduction of the inferior nasal concha

Before performing surgery using radio waves, a number of clinical tests must be performed.

Donate blood and urine for a general clinical analysis, blood for the presence of coagulation, undergo fluorography this year, and women should contact a gynecologist for examination.

After consultation with an ENT doctor, the patient is assigned a date and time for radio wave destruction of the lower nasal passages.

Just before surgical intervention The specialist conducts a final consultation and explains the course of the upcoming procedure. If the patient feels anxious and is afraid to undergo surgery, he may be asked to drink lungs. sedatives. He can also ask questions about the progress and consequences of the surgical intervention.

Progress of radio wave reduction of the inferior turbinates:

1. Administration of anesthesia in the form of an injection or by lubricating the nasal passages with cotton gauze wipes soaked in a special anesthesia solution. In any case, the effectiveness of the product will last up to four hours, after which sensitivity will return.
2. The doctor places electrodes from the device into the inferior nasal turbinates, which act on the soft fabrics nasal passages. After which they are removed.
3. During the procedure, the specialist monitors the external condition of the patient.

Advantages of radio wave vasotomy of the inferior turbinates

The main advantages are:

1. The procedure is easily tolerated by the patient.
2. No nosebleeds occur during this procedure.
3. According to statistics, radio wave disintegration indicators of the inferior turbinates are highly effective.
4. During the postoperative period, painkillers are used in in rare cases, tight tamponade of the nasal passages is not performed at all.
5. After the procedure, minor scars remain on inside nasal mucosa.
6. The procedure is carried out under sterility control, all aseptic and antiseptic measures are observed while maintaining the sanitary anti-epidemic regime.

Recovery period

In the postoperative period, swelling of the nasal passages persists, and breathing is not fully restored at this time. The patient must come for examination as prescribed by the doctor. In general, the rehabilitation period lasts no more than fourteen days, during which it is necessary to lead a careful lifestyle and try to protect yourself from long-term physical activity.

Video of radio wave vasotomy of the nasal turbinates

Vasotomy is an operation aimed at reducing the size of the nasal mucosa. It comes down to the destruction of a part choroid plexuses located between the epithelium and bone. The main indication is chronic runny nose and the resulting hypertrophy of the mucous membrane.

Indications for surgery

The main disease for which vasotomy is possible is a chronic or runny nose. An important condition Surgical treatment is to get rid of the underlying infection and exclude the allergic nature of the disease.

Hypertrophy of the nasal mucosa can also be a reason for prescribing vasotomy. These two pathologies are related, but not directly. Hypertrophy may be a consequence persistent runny nose, taking vasoconstrictor drugs, which suppress its function and cause the mucous membrane to grow to compensate. But it can also arise as a result. Hypertrophy often increases during adolescence.

Vasotomy can help with addiction vasoconstrictor drugs. In this case, the swelling does not subside without taking the appropriate drops. For some people, addiction can last for years, and only surgery helps them begin to breathe on their own.

Operating principle

The operation area is the inferior nasal turbinates. X surgery may affect only the left or right side or be two-way. The last option is carried out most often, since the vasomotor chronic rhinitis affects both nostrils.

The inferior turbinates are bony protrusions that are covered with epithelium containing many glands. Because of them, the surface is constantly wetted with mucus and is therefore called mucous. It is characterized by increased blood circulation. Therefore, another layer is usually isolated between the bone and epithelial tissue - the submucosal layer. It consists of choroid plexuses.

They are the ones that are destroyed during the operation. As a result, nutrition of this part of the epithelium stops. It dies and scars appear. The total volume of hypertrophied mucosa decreases. This relieves swelling, reduces the activity of the glands, which ultimately eliminates the runny nose.

Types of surgery

Vasotomy of the inferior turbinates can be performed using one of the following methods:

• Instrumental. In this case, the surgeon acts directly with a scalpel, making an incision into the mucous membrane.
• Laser. The action of the beam is directed to the entire surface of the mucous membrane. The risk of infection is reduced, but the effectiveness does not always correspond to the damage caused.
• Radiocoagulation. The surgeon makes punctures; an instrument with a tip through which radio waves pass is inserted.
• Vacuum resection. This is a new method that at the moment is being actively researched. The destruction of the submucosal layer is carried out by introducing a tube connected to a pump under the epithelium and creating negative pressure.
• Ultrasonic disintegration. The waves are focused exclusively on the affected area. Risk additional damage minimal.

Progress of the operation

Instrumental vasotomy

The procedure is performed under local anesthesia. It is carried out by lubricating the mucous membrane with a 5% solution of cocaine or a 2% solution of dicaine. The entire nasal turbinate is also infiltrated (impregnated) with lidocaine (1%) or novocaine (1-2%). Sometimes they are given by injection. The patient's face is covered with a napkin, leaving an opening for the nose. Thus, the patient does not see the doctor’s actions. The operation time is from 30 to 60 minutes.

After the anesthetics begin to take effect, the surgeon makes a 2-3 mm incision down to the bone. A raspatory, a tool for separating tissue, is inserted into it. The surgeon separates the mucous tissue in the required volume. As a result, scars appear at the site of the choroid plexuses, and the epithelial tissue decreases in size.

Sometimes lateropexy is necessary– shift of the nasal concha to the side maxillary sinus. The patient may hear a crunching sound at this moment; do not be alarmed and try to move your head.

After the operation, the patient is given another injection with an anesthetic, to reduce discomfort after the anesthesia wears off. Bandages or tampons will remain in your nose for some time. On the first day, the condition may resemble flu - lacrimation, weakness, dizziness. Important! However, there should be no temperature - this is a sign of inflammation or infection. The patient will need to rinse his nose periodically in the morning to prevent crusting. This procedure is carried out until the mucous membrane is completely healed and its normal functioning begins.

Laser vasotomy

Before surgery, you must refuse cosmetics. It is possible that the patient will be asked to change into disposable hospital pajamas. The operation is performed under local anesthesia. The pain medication is most often delivered in the form of tudundas soaked in analgesic, which are inserted into the nose. The patient's face is treated with alcohol.

Sometimes, as a result of changes in the mucous membrane, it loses color and becomes pale. In such a situation, it is difficult for a doctor to carry out all the necessary manipulations, so before the operation the epithelium is stained with methylene blue. This also improves the performance of the laser.

The patient lies on the couch, his head is placed on the headrest. Important! It is extremely undesirable to move during the operation, so you need to immediately take a comfortable position. If the patient feels overly excited, it is better to ask the doctor to immobilize the arms and legs with elastic bandages. A blindfold is put on the eyes. During the operation, the patient will feel an unpleasant burning odor. It will be optimal if he inhales through his mouth and exhales through his nose.

The doctor inserts a mirror into the nose and uses it to control the process. It is usually painless, but a slight tingling or pinching sensation may occur. Radiation can be carried out pointwise or continuously, when the doctor runs the laser along the mucous membrane. The first method is the most preferable because it has less impact on the epithelial lining of the nose. Today at medical centers First, they use the least traumatic method, and if it is ineffective, they move on to the second.

The actual operation is carried out with quartz fiber. It is injected under the mucosa and forms channels there, separating the tissue. The fiber is flexible, which allows it to follow all the contours of the nasal concha and not extend to the surface of the epithelium.

After the operation, tamponade (insertion of tampons into the nose) is not required, since in most cases it is bloodless, because the vessels are not cut, but “sealed”. This prevents the development of synechiae - tissue adhesions. Laser vasotomy has good efficacy and safety indicators. As doctors from Kharkov write (O.G. Garyuk, A.B. Bobrus), who conducted a long-term study of patients with drug-induced rhinitis in the period from 2006 to 2009, cure occurs in 96.8% of cases.

Video: performing laser vasotomy

Radio wave vasotomy

The immobility of the patient is one of the key parameters, so in most cases the patient falls asleep during the operation. The anesthetic is delivered through a vein. A tube is placed in the throat to drain the blood. Operation time is from 10 to 40 minutes. If the doctor uses local anesthesia, then the patient should control his reactions as much as possible during radio wave vasotomy and try not to move even in case of severe pain.

The doctor inserts a probe into the submucosal area. A radio wave appears between it and the transmitter. Due to wave resistance the surrounding tissues heat up and are destroyed. One variation of the method is the use of non-thermal energy. At certain frequencies, a cooling area appears around the inserted probe, which causes tissue destruction. This method is considered somewhat less traumatic than the standard one and safer for neighboring tissues.

The patient usually wakes up 1-2 hours after the end of the operation in the ward. There are tampons and tubes in the nostrils through which you can breathe. General condition the patient is satisfactory. Patients usually note severe pain in the nose and prefer to breathe through the mouth. Migraines and spatial disorientation are possible. During the week, it is necessary to observe hygiene measures - rinsing the nose with saline solutions, such as Aquamaris, removing crusts from the nose using Vaseline or peach oil.

Ultrasonic disintegration

The operation is performed in the ENT office. She carried out under local anesthesia and lasts from 5 to 20 minutes. There may be some bleeding, so the patient will likely be wearing a special apron. A waveguide is inserted into the submucosa of the patient's inferior turbinates. It looks like a needle, with which the doctor “pierces” the epithelium.

The ultrasound emitted causes stenosis (sticking together) of those blood vessels which provoke swelling. After the operation is completed, tampons are inserted into the patient's nostrils and he can go home. In the evening, ichor may be released - this is a normal reaction. Nasal breathing is completely restored 3-7 days after surgery. It is necessary to periodically see a doctor to remove crusts of mucus during the recovery period.

Vacuum resection

The operation is performed under local anesthesia and under strict endoscopic control. A device for performing vacuum resection was developed by Russian doctors and put into practice just a few years ago. It is a system of tubes with a pump attached to them.

The surgeon makes an incision with a scalpel after the onset of anesthesia. A tube is inserted into the submucosal layer. Its edge is sharp, and as it moves, it cuts off the tissue needed to be removed. Due to the action of the pump, they are sucked into the tube along with the blood.

After removing the device from the nose, it is inserted into the nostril cotton ball which presses tightly epithelial tissue. This is necessary to prevent bleeding. It stays in the nostril for only 30-60 minutes. Tamponade is not required for vacuum resection.

Deleted content is sent to histological examination. This allows for more careful planning of further patient management.

Vasotomy combined with septoplasty

stages of septoplasty

One more common cause breathing disorders in addition to hypertrophy of the mucous membrane is a curvature of the nasal septum. This pathology can also be corrected surgically. The operation is called . Since chronic rhinitis and deviated septum - associated diseases, it is often suggested to carry out immediately this operation together with vasotomy.

Such a surgical intervention is more difficult than just excision of the submucosal layer of the nose, and lasts longer. Therefore, in this case, more often They practice general anesthesia and hospitalization for 1-2 days after surgery. And yet Most surgeons recommend performing septoplasty and vasotomy together rather than in two stages. This reduces trauma to the mucous membrane and discomfort for the patient, which only has to be experienced once.

The recovery period after such an operation lasts longer than with a conventional vasotomy. There may be an increase in temperature and prolonged separation of ichor from the nose. Important! If you feel unwell, you should contact your ENT specialist; only a specialist can distinguish the body’s normal reaction from the onset of an infectious process.

Complications after vasotomy

After surgery, the following undesirable consequences may develop:

1. Atrophy of the mucous membrane. This is the reverse process of hypertrophy, but also unpleasant. The lowest risk of its occurrence is after laser exposure. Atrophy is caused by functional destruction significant cells epithelium of the nasal passages.
2. Inflammation. The risk of infection during surgery is quite low. All tools, both private and public clinics undergoing sterilization. However, any surgical intervention reduces the protective barrier of the epithelium, which makes the body more susceptible to various pathogens. The more invasive the method is used, the more likely get inflammation.
3. Loss of sense of smell. This is usually a temporary phenomenon associated with post-operative swelling.
4. Nasal congestion. Unfortunately, nasal vasotomy may not always help. It is extremely rare that swelling and congestion not only do not go away, but also become stronger. The reasons may vary from allergic reaction until re-hypertrophy.
5. Formation of synechiae or adhesions at the resection site. These formations can seriously make breathing difficult. They form gradually, so the patient’s well-being may not deteriorate immediately. Treatment is carried out only through repeated surgery.

Some authors do not consider the safety of the effects of physical radiation (radio or laser) on the human body to be conclusively proven. Modern research are not grounds for prognosis of the patient's condition in the more distant future.

Price

Submucosal vasotomy is performed free of charge, but you will have to stand in line to receive the service. Patients usually have to wait from 1 to several months. The operation is carried out mainly instrumental method. It is possible, if the clinic or hospital has special equipment, to perform vacuum resection according to compulsory medical insurance policy However, this practice is still extremely rare.

Other types of vasotomy cost approximately the same - from 5,000 to 15,000 rubles. Additionally, you will have to pay for general anesthesia if such is the doctor’s testimony or the patient’s desire. The cost of tests, biopsy of the contents, as well as hospitalization beyond the first day are not included in the indicated price. Clinic price lists usually imply bilateral vasotomy, although this is not indicated separately.

The most expensive operation will be combined with septoplasty, mainly due to hospital stay. Average price in Moscow is 50,000 rubles. But septoplasty itself can be performed free of charge under the compulsory medical insurance policy, but you should not expect the combination of this operation with vasotomy performed using a minimally invasive method using modern equipment.