Runny nose

Experience in the use of submucosal radiocoagulation of the inferior turbinates. Laser destruction of the inferior turbinates Laser coagulation of the nose

Bone structure skulls – complex system With a large number constituent functional elements. These include the inferior nasal turbinates - paired bone formations located in the nasal cavity. Anatomically, they are bone plates that separate the middle and lower nasal passages and participate in the formation of the latter. The inferior nasal turbinates are formed bone tissue, and are lined with submucosal tissue, which contains glands and plexuses of many small vessels, and is covered with epithelium on top. The vessels, expanding and contracting, regulate the diameter of the lumen of the nasal passages, that is, they take part in the regulation of human breathing.

Anatomical features of the structure of the inferior nasal concha

This paired thin bone has a concave lateral and rough medial surface. The rough is covered with multiple vascular grooves.

Its upper edge is straight, at the back it is attached to the palatine bone, and at the front it is attached to the conchal ridges. upper jaw, as if throwing itself over its crevice.

The structure of the shell is represented by a body and three processes. The maxillary process and bone form acute angle, which includes the lower edge of the cleft of the upper jaw. During the opening of the maxillary sinus, this process is clearly visible.

The lacrimal process connects the lacrimal bone and the inferior concha.

The ethmoid extends from the junction of the bone with the maxillary process and ends at maxillary sinus. It can fuse with the ethmoid bone in its uncinate process.

The anterior section of the shell at the upper edge is attached to the conchal maxillary crest. Her posterior section attached to the conchal crest of the perpendicular plate of the palatine bone. A longitudinal slit located under the shell is the lower nasal passage.

The vascular component of the submucosal layer covering these shells is directly involved in the breathing process, narrowing and expanding under the influence of external and internal factors. In cold weather, the vessels in the nasal passages dilate, due to which air passes through them more slowly and has time to warm up better before entering the lungs. In general, lower shells are characterized by high intensity blood flow

However, there are conditions, pathologies and diseases in which normal regulation vascular tone may be impaired, for example, during pregnancy, due to a deviated nasal septum, due to certain endocrine diseases And allergic rhinitis. In this case, the vessels located under the mucous membrane fill with blood, as a result of which the mucous membrane thickens and breathing becomes difficult. Complications of such conditions are vasomotor rhinitis and hypertrophy of the inferior turbinates.

What are the dangers of nasal turbinate pathologies?

A dangerous feature of any changes in the structure of the turbinate mucosa is that, due to difficulty in nasal breathing, the affected person is constantly forced to use vasoconstrictor sprays and drops. The use of such medicines which continues for a long time can cause a whole series complications:

chronic hypoxia;
formation of dry rhinitis in chronic form when crusts form in the nasal cavity, and fluid with ichor separates from the nose;
damage to the ciliated epithelium;
chronic nasal spasm, due to which a person develops hypertension;
difficult passage auditory tubes And pathological processes in the paranasal sinuses and structures of the middle ear.

The essence of the vascular vasotomy procedure, indications and contraindications for its use

Submucosal vasotomy is a process of surgical intervention on the vascular connections lining the cavities of the nasal turbinates. Thanks to its implementation, it is possible to significantly reduce the size of the mucous membrane, thereby facilitating the process of nasal breathing for the person being operated on.

Indications for vasotomy are:

chronic rhinitis in cases where the variant of its allergic etiology is excluded;
diagnosed hypertrophy of the nasal mucosa;
deviated nasal septum;
dependence on vasoconstrictor drugs.

In what cases is the operation impossible? Doctors identify the following contraindications to vasotomy:

blood clotting disorders that cannot be corrected;
acute infectious lesions;
atrophic and ulcerative lesions nasal mucosa;
cardiac, hepatic, renal failure in the stage of decompensation;
diabetes mellitus;
period menstrual flow in women.

Vasotomy techniques: how destruction of vessels in the submucosal turbinates occurs

Vasotomy is performed in various ways. For each specific patient, the doctor selects the most suitable method. So, they distinguish:

instrumental;
laser vasotomy;
radiocoagulation;
ultrasonic disintegration;
vacuum resection.

Instrumental vasotomy involves using a scalpel to cut the mucosa.

The laser type of procedure is carried out using a directed laser beam, which destroys accumulations of blood vessels with minimal tissue trauma.

Radiocoagulation is the process of influencing the vessels of the submucosal tissue through the use of a radio wave source.

Ultrasonic disintegration is based on the impact of ultrasonic waves on the affected area.

Vacuum resection is carried out by introducing a pump tube with negative pressure into the submucosa, as a result of which the vessels and tissues are destroyed.

Preparation for the procedure, features of the procedure

As preoperative preparation The doctor prescribes some preliminary tests - a coagulogram, a general blood test, a throat smear, and also a rhinoscopy.

If there are infectious foci or inflammation, special therapy is prescribed to eliminate them. Before the operation, the doctor performs sanitation oral cavity.

Each type of vasotomy is performed according to a specific scheme. The operation can be bilateral or unilateral.

Instrumental vasotomy. Carried out using local anesthesia. The mucous tissue of the shells is lubricated with a solution of dicaine, in addition, the tissue is infiltrated with lidocaine or novocaine. Injection anesthesia is allowed.

When the anesthesia begins to take effect, the surgeon makes an incision up to 2-3 millimeters long. It reaches deep into the bone. A raspator is inserted into the hole, with which the doctor removes the required volume of mucous membrane. As a result, the size of the epithelium decreases, and scars form in place of the separated tissues.

Instrumental vasotomy with lateropexy implies, in addition to affecting the mucous membrane, also moving the nasal concha towards the maxillary sinus.

At the end of the procedure, the patient is given an injection of an anesthetic, since after the anesthesia wears off, he will feel significant soreness at the operation site. IN nasal cavity Gauze swabs are inserted and cannot be removed during the first 24 hours.

The normal state after instrumental vasotomy is weakness, apathy, increased tearfulness, and dizziness. Mandatory requirement rehabilitation process is the need for daily nasal rinsing to prevent the formation of crusts.

Laser vasectomy. Also held under local anesthesia. Typically, cotton swabs soaked in anesthetic are used and inserted into the nose.

To better visualize changes in the epithelium, it is stained with methylene blue before the intervention begins.

The patient is placed on the couch, his head is located on the headrest. Special ones are put on the eyes safety glasses or bandage. While the surgeon operates the laser, the patient must lie completely motionless. You need to breathe through your mouth during the process so as not to feel the characteristic “scorched” smell.

A surgical speculum is inserted into the nose, giving the doctor an overview of the surgical site. Next, the source is inserted laser radiation– a special sensor that the surgeon continuously moves across the mucous membrane, or acts on it pointwise.

The effect of cutting off excess tissue is produced by introducing quartz fiber into the submucosa, which forms channels in it. At the same time, the laser beam also produces coagulation of blood vessels, so the operation is bloodless and does not require tamponade, and does not cause tissue fusion.

The operation can last from 30 to 60 minutes.

Radio wave interference. In this case great value the person being operated on has complete immobility, so he is often immersed in a state medicated sleep by administering the anesthetic intravenously. A tube is inserted into the throat to drain the blood. Next, a special probe is inserted into the submucosa. A radio wave of a certain length is produced between it and the transmitter. Due to the resulting tissue resistance, they heat up and collapse. Non-thermal exposure is considered safer when a strongly cooled area appears around the inserted probe, which also leads to the destruction of pathologically altered tissue.

At the end of the procedure, the patient is transferred to the ward. When the anesthesia wears off, the person may feel severe pain in the nose, spatial disorientation is also possible.

For next week after surgery, the nasal cavities must be washed with disinfectants saline solutions, and the crusts must be removed using peach oil or Vaseline.

The total duration of the process is no more than 40 minutes.

Ultrasonic disintegration. It is performed in the ENT office, meaning there is no need to transfer the patient to the operating room. The doctor puts a protective apron on him, as bleeding may occur. A conductor of ultrasound waves in the form of a spoke is introduced into the submucosal tissue of the shells, which pierces the epithelium.

Due to ultrasound exposure, the vessels become stenotic, that is, they stick together, and they can no longer provoke the appearance of edema.

At the end of the procedure, sterile gauze swabs are inserted into the nostrils, and the patient can go home.

On the first day, the normal reaction of the mucous membrane will be the separation of ichor. In 3-7 days nasal breathing completely restored.

If the mucus crusts that form cause discomfort to a person, you should consult a doctor to have them removed.

The duration of ultrasound vasotomy is from 5 to 50 minutes.

Vacuum resection. This type of operation is performed under local anesthesia, as well as endoscopic control. Once the anesthesia begins to take effect, the surgeon makes an external incision with a scalpel and then inserts a vacuum tube into the submucosa. The tube has a sharp edge, and as it moves inside the tissue, it partially cuts them off. The pump to which the tube is connected creates negative pressure in it, and all cut-off tissues, along with blood, enter its cavity.

The surgeon, removing the tube, inserts a cotton swab or ball into the nostril, with which the epithelium is tightly clamped at the site of the incision in order to prevent the development of bleeding. After 30-60 minutes the ball is removed.

Vasectomy and nasal septum correction

In cases where the cause of breathing problems, in addition to problems with the mucous membrane, is a deviated nasal septum, the surgeon can also perform septoplasty during the operation. This surgical intervention is more complex and is performed only under general anesthesia, and requires placing the patient in a hospital for 1-2 days.

The recovery period after this operation lasts 14-20 days, it may be accompanied by an increase in temperature, separation of mucus and ichor. At least once per time postoperative rehabilitation you need to see a doctor.

What happens after surgery: patient reviews and medical practice

Despite the relative safety of vasotomy, the patient is not immune from the development of certain complications or unpleasant consequences interventions. Thus, the affected person may develop mucosal atrophy - a process that is the opposite of tissue hypertrophy, when mucosal cells begin to deteriorate and die.

The risk of blood and tissue infection during surgery is quite low, but it cannot be completely excluded.

Impaired sense of smell awaits the patient after any method of vasotomy, but if the intervention was gentle and qualified, the ability to smell will return fairly quickly.

Some reviews from those operated on say that the submucosal tissues grew almost stronger after the vasotomy than before it. Unfortunately, vasotomy cannot always affect the cause of tissue hypertrophy and is guaranteed to relieve nasal congestion, so re-growth of the epithelium is quite difficult to exclude.

In addition, at the site of the resection, fusions of tissues and vessels - synechiae and adhesions - can form. You can get rid of them only by repeating the operation.

Usually, if all the rules of asepsis and intervention technique are observed, in 93-97% of cases vasotomy is successful, and within a month after it normal nasal breathing is finally restored. The probability of relapse ranges from 25 to 40%.

Many people treat their body with a fair amount of indifference when it begins to show the first signs of serious illnesses. This happens especially often when a runny nose appears. There is an opinion that you can just “sniff” your nose for a couple of weeks, take well-known pills, maybe use some kind of spray, and everything will go away by itself. However, otolaryngologists insist that rhinitis should be taken more seriously, because it can cause the development of ailments such as sinusitis, sinusitis and even hypertension.

In cases where a person has already thoroughly launched the mechanisms for the development of any infection in his body, drops, sprays and tablets are unlikely to help. Therefore, there is a need for surgical treatment methods. It's about about laser coagulation performed inside the nasal sinuses.

Cause and effect – rhinitis and laser

Chronic rhinitis is a disease that affects the mucous membrane of the nasal cavity. It is characterized by the following symptoms:

stuffy nose;
difficulty breathing;
copious secretion of mucus from the sinuses;
headache;
heavy snoring;
general malaise.

In the absence of proper treatment, chronic rhinitis quickly acquires severe form and provokes the development of other diseases that are not so easy to treat. The disease is divided into several types:

– it reduces the tone of the vessels that are located in the inferior turbinates (in the submucosal layer);
allergic rhinitis - the cause is individual intolerance to a certain irritant (clogging of the cavity and narrowing of blood vessels occurs);
medicinal rhinitis - appears as a result of long-term use of nasal sprays and vasoconstrictors;
– is a consequence of any of the above rhinitis and is accompanied by an increase in volume connective tissue in the mucous membrane of the nasal concha.

Photo A - normal vessels, photo B – extended

If one of these types of chronic rhinitis is detected, the doctor may advise taking antibiotics, which is associated with a certain risk, or performing surgery and cleansing the nasal turbinates and narrowing the blood vessels in a fairly short period of time.

The operation itself is classified as simple and does not involve any risk to the health and life of the patient (provided the doctor is sufficiently competent).

How is laser coagulation performed?

Laser coagulation is the most gentle and at the same time effective way eliminate the causes and symptoms of all types of chronic rhinitis. In this case, the patient completely relieves the dependence that arises as a result long-term use drugs. During the operation, the specialist uses a laser beam, which destroys (cauterizes) the vessels located under the nasal mucosa. The consequence of this procedure is the disappearance of edema, the restoration of normal breathing and the elimination of the possibility of the nasal turbinates enlarging. Sometimes the operation is called vascular vasotomy.

Vasotomy is a dissection of the vessels between the periosteum of the nasal turbinates and the mucous membrane, leading to a reduction in the turbinates, contraction of the mucous membrane and full restoration physiologically correct breathing through the nose.

Laser coagulation of the nasal vessels has a number of advantages compared to instrumental surgery. First of all, it is more quick effect. Normal breathing becomes possible directly on the day of surgery. Also, the advantages are low invasiveness (minimal destruction of tissues and blood vessels) and the absence of the risk of injury. The operation takes approximately 15 minutes and is performed under local anesthesia on an outpatient basis (in a clinic or hospital). Another advantage is the stable result - the vast majority of patients who have undergone the procedure do not experience relapses for many years.

Progress of the procedure

During the operation, the patient lies on the surgeon's table on his back. Immediately before the procedure, the doctor uses local anesthesia, the effect of which begins to be felt after 3-5 minutes. When the laser is operating, the patient is absolutely prohibited from moving his head. different sides. You need to breathe like this: inhale through your mouth, exhale through your nose. During the doctor's work, a person feels only a slight tingling sensation, which does not cause any discomfort.

The laser gently affects tissues and blood vessels without affecting other areas

After the anesthetics have fully begun to take effect, the specialist uses a laser to form channels along the lower and upper edges of the nasal turbinates. At the same time, the progress of the operation is controlled by an endoscope, which will prevent the laser beam from exiting beyond the area being treated.

This is what the device looks like, with the help of which laser coagulation of the nasal turbinates is carried out

When the operation is over, the medical staff closely monitors the patient for half an hour, performing procedures such as oropharyngoscopy, anterior rhinoscopy and endoscopic examination. If during this period of time there is no bleeding from the vessels or shells in general, then the patient is allowed to take vertical position. In short postoperative period(several hours) the patient is also under the supervision of a doctor. If no abnormalities are found during this time, the patient is released.

Before leaving the clinic, a person receives a lot of instructions. In particular, anyone who has undergone laser coagulation of the nose is strictly prohibited from using any drugs to treat the nose. Also prohibited physical activity, visiting saunas and baths, drinking alcohol (the latter categorically). Nose care is carried out only with products that were prescribed by a specialist (various oil drops).

Even though positive effect achieved on the day of surgery, in most cases one procedure may not be enough. As a rule, a whole course of procedures is carried out, which includes from 2 to 6 sessions. The interval is from 1 week to 5.

Laser coagulation of the nose is considered in a great way get rid of chronic rhinitis, but it is much better not to let it get to you. Therefore it is necessary to use medications as soon as the disease was diagnosed. However, if rhinitis has started, then you should not double-down on medications. You need to immediately think about more effective and reliable methods of treatment, before the course of the disease initiates the development of another, more serious and dangerous ailment.

A runny nose is a symptom that worries every person at least 1-2 times a year. Despite the fact that discharge from the nasal passages does not seem at first glance big problem, many people will disagree with this. After all, sometimes a runny nose can bother a person constantly. Not only does it interfere with leading a normal lifestyle (interferes with breathing, sleep). In this case, common medications (vasoconstrictors) do not bring the desired effect or only help short term. Then the doctors suggest surgical method treatment. This means vasotomy of the nasal turbinates. a procedure that helps get rid of chronic rhinitis and other diseases.

Vasotomy of the nasal turbinates - what is it?

The fight against a runny nose can last for years. As is known, some vasoconstrictors differ in that they are addictive. Therefore, when they are canceled, the runny nose starts again. Chronic rhinitis is serious problem, since this disease is difficult to treat with medication. Especially in cases where the cause of increased mucus secretion is due to allergic reactions or lifestyle features (working with dust, chemicals). IN similar situations The best solution is considered to be turbinate vasotomy. What is it and how effective is the procedure? Similar questions interest almost every patient who is recommended this method treatment. To understand the essence of surgical intervention, you should learn about the changes that occur in the nose during chronic rhinitis.

As with any inflammatory process, the mucous membrane becomes thicker due to edema. This leads to increased secretion production. For these reasons, air has difficulty passing through the nasal passages. Due to prolonged runny nose hypoxia of the brain occurs. To avoid dangerous complications, turbinate vasotomy is recommended. What is it? Vasotomy means excision of tissues that have undergone chronic inflammation. As a result of this procedure, the blood supply to the mucous membrane is disrupted, its thickness is reduced and air access is improved.

Indications for surgery on the nasal turbinates

Surgery (lower vasotomy is indicated only if drug treatment is ineffective. In addition to chronic rhinitis, surgery is also performed for other pathologies. There are the following readings to the operation:

Hypertrophy of the mucous membrane of the nasal concha. This disease can be caused not only by a runny nose, but also be an independent pathology. Hypertrophy often develops during puberty.
This disease develops due to abundant blood supply to the mucous membrane of the nasal turbinates and exposure to predisposing factors.
Accustoming to vasoconstrictors. Long-term use drops from a runny nose leads to the fact that a person cannot refuse them. Withdrawal of drugs only causes increased swelling and mucus production.
Adhesive processes in the nasal cavity.
Epithelial hyperplasia.
leading to disruption of passage passages.

In these cases drug treatment will not bring the desired effect. Submucosal vasotomy of the inferior turbinates is the only method of getting rid of a runny nose. Excision of tissue can be carried out on one side or both.

Contraindications to turbinate vasotomy

Despite the fact that surgery is not considered a complex procedure and can be performed in outpatient setting, it is not indicated for all patients. There are cases when submucosal vasotomy of the turbinates is prohibited. Therefore, before you decide to similar procedure, you should consult an otolaryngologist. There are a number of contraindications to vasotomy. Among them:

Pregnancy and period breastfeeding. Considering that the operation is not an emergency surgical procedure, it is recommended to postpone it until delivery or cessation of lactation.
Acute infectious pathologies.
Exacerbation of diseases of the upper respiratory tract. If there is a focus of inflammation (sinusitis, laryngitis), the nasal cavity can become secondarily infected at the time of surgery and after it.
Blood diseases accompanied by insufficiency of platelets or clotting factors. In these cases, vasotomy is contraindicated due to the risk of hemorrhagic shock.
Mental pathologies.

Preparation for surgery

Submucosal vasotomy of the inferior turbinates is performed only in cases where the doctor can exclude all contraindications. For this purpose, it is necessary to undergo an examination. The otolaryngologist prescribes tests such as OBC and coagulogram. It is important to pay attention to platelet levels and clotting time. Infectious pathologies should also be excluded. To do this, a thorough history is taken. The doctor finds out whether the patient has had contact with people who are sick infectious diseases. To exclude inflammation of the respiratory tract, pay attention to the level of leukocytes in the blood, examine back wall nasopharynx, lymph nodes. By specific method examination is rhinoscopy. It is necessary to assess the mucous membrane of the nasal passages and their patency. The procedure is performed quickly on an outpatient basis.

Technique for performing turbinate vasotomy

Most often, the operation is performed on the inferior turbinates on both sides. During the procedure, the patient sits on a chair. The duration of the operation is about 15-30 minutes. Before proceeding with vasotomy, the nasal passages are anesthetized. There are several varieties of this surgical intervention. Among them:

Instrumental method. Performed using a scalpel. The mucous membrane is excised, and the vessels are coagulated (“sealed”).
Laser vasotomy of the nasal turbinates - bloodless and painless method surgical treatment. Currently it is the most common method.
Cryodestruction - cauterization of the mucous membrane with liquid nitrogen.
Vacuum resection. It is carried out by introducing a special tube into the submucosal layer and creating negative pressure. The hypertrophied tissue is aspirated, causing the epithelium to noticeably narrow.

Sometimes vasotomy is combined with turbinoplasty - excision of the nasal septum. In some cases, conchotomy is indicated - removal of not only hypertrophied tissue, but also polyps.

How does the postoperative period proceed?

After vasotomy, it is not necessary to perform cavities, since the vessels are coagulated during the operation. Therefore, the risk of bleeding is minimal. However, a rhinoscopy is performed a few minutes after surgery. The healing process lasts about 1 week. To speed up regeneration, it is recommended to use inhalations into the nasal passages. At first you can’t go to the bathhouse or take hot bath, as this may promote bleeding.

Possible complications

In most cases, the operation is not dangerous. However, complications such as infection of the mucous membrane or bleeding are possible. If it was removed too large number vessels, the blood supply to the mucous membrane is disrupted. This is dangerous due to the development of atrophy and necrosis.

Vasotomy of the nasal turbinates: reviews from patients and doctors

If the operation is performed correctly, the risk of complications is minimal. Therefore, for chronic rhinitis and epithelial hypertrophy, vasotomy of the inferior turbinates is recommended. Reviews from patients who have undergone surgery are positive. They note an improvement in their condition and the absence of a runny nose that makes breathing difficult. Otolaryngologists often recommend this procedure as a method of treating chronic rhinitis.

The inferior turbinates are bony protrusions on the side walls of the nose, covered with a mucous membrane under which there is a very developed submucosa. There are many venous plexuses in the submucosal layer, which is due to main function this part of the respiratory tract - by heating and humidifying the air entering the body.

Why is vasotomy of the inferior turbinates necessary?

Venous plexuses tend to enlarge when filled with excessive blood. For example, this happens in acute viral runny nose. As a result, they swell, the lumen of the nasal passages narrows, and breathing itself becomes difficult.

Pathological enlargement is the main problem in various types runny nose (allergic, medicinal, vasomotor, etc.). The venous plexuses in this case are constantly overflowing with blood. This problem can be solved using radical methods - surgical operations.

The main problem is that this part of the airway cannot be completely excised. Normal breathing depends on many factors, that is, the width of the space through which the air passes is not the main factor. If you carry out complete removal, then the effect can be exactly the opposite - the person begins to feel that breathing has worsened significantly.

In addition, the trajectory of the air stream changes, chronic inflammation occurs, and crusts constantly form. So all surgical methods are aimed at reducing the volume of shells, preserving their mucous membrane and shape.

These types of surgery have different names, but involve the same actions. Terms may appear in different combinations, for example, laser reduction, ultrasound and radiofrequency reduction, radio wave or laser, ablation and vasotomy of the inferior turbinates.

Vasotomy is understood as an incision of a vessel, ablation - cutting off, removal, disintegration and destruction - complete or partial destruction, coagulation - cauterization, resection and conchotomy - partial cutting off, conchopexy - a slight change in localization and fixation, reduction - reduction in volume, turbinoplasty.

Very often, destruction, reduction, vasotomy, disintegration, coagulation mean the same procedure:

Electrocautery (electrocautery, electrocoagulation) is a method that involves the use of direct current, which heats the surgical probe to high temperatures. As a result, tissue cauterization occurs;
Radio wave (radio frequency) vasotomy of the nasal turbinates involves exposure to variables high frequency current, generating radio waves. The latter, passing through the tissues, cause their heating and destruction;
Coblation, or cold plasma reduction, is a method similar to radio wave. A kind of cold field is formed around the working instrument, which has a destructive effect on the submucosal layers;
Laser vasotomy (coagulation, destruction, etc.) of the inferior turbinates is a method, as the name implies, that involves exposure to a laser: the beam heats and destroys tissue;
Ultrasonic vasotomy (disintegration, destruction, ultrasound) – tissues are destroyed using ultrasound;
Cryosurgery, or cryodestruction - the method involves using low temperatures. The tissues are first frozen and then destroyed;
Conchotomy (resection) is a mechanical destruction consisting in removing part of the shell and its mucosa;
Shaver methods are similar to the previous one.

Electrocautery method

This type of surgical intervention is based on the impact electric current: an electrode is inserted into the shell, which, when heated, causes a burn to the tissue of the submucosal layer. Subsequently, this place becomes scarred, compression and desolation of the venous plexus occurs, and the shell decreases in volume. The electrode is heated by direct current, which does not go beyond the device.

Bilateral radio wave vasotomy of the inferior turbinates

This method involves introducing a special probe. Using alternating current, radio waves are generated that heat the surrounding tissue to the point of destruction.

Again, desolation of the venous vessels occurs and the shell decreases in size.

Radio wave vasotomy differs from electrocautery in that the tissues themselves are heated, and in the second case only the device used to perform the manipulations is heated.

Coblation

This method is part radio wave surgery. During surgery, tissue is exposed to non-thermal radiofrequency energy. A field of so-called cold plasma is formed around the device being manipulated. As a result soft fabrics are destroyed at relatively low temperatures. This option does not involve thermal effects; accordingly, surrounding tissues are less injured than with laser or radiofrequency coagulation.

Laser vasotomy, or destruction, of the nasal turbinates

During the operation, a light guide is used. The tissue under the mucous membrane is vaporized by the energy of the laser beam. As a result, the shells decrease in volume.

Submucosal ultrasound vasotomy of the inferior turbinates

As in previous cases, a special tool– ultrasonic probe. In the process, limited destruction of the submucosal layer occurs under the influence of ultrasound.

Cryodestruction

This type of operation involves exposure to low temperatures. All actions are performed with a special cryoprobe.

When the latter touches the mucous membrane, the resulting ice crystals destroy the walls of tissue cells.

Cryodestruction provokes thrombosis of small vessels in the treated area and local bleeding. Such destructive measures will significantly reduce the volume of shells.

Vasotomy and submucosal lateralization of the turbinates

These two methods are purely mechanical. All actions involve mechanical destruction of blood vessels in the submucosal layer. Any destruction (laser, radio wave, etc.) can be considered a vasotomy. However, if anywhere it is simply stated “ submucosal vasatomy", then, most likely, the reduction of shells is carried out with an instrument that causes mechanical destruction, for example, a surgical chisel.

Lateralization is a mechanical maneuver: the surgeon breaks the concha at its attachment point and moves it to the side wall of the nose, thereby expanding the space for air flow into the body.

The natural ability for nasal breathing can be greatly impaired by hypertrophy of the nasal mucosa. And sometimes such a problem can only be dealt with through surgical intervention.

In response to severe runny nose there is an increase in the venous plexuses, which are localized in the nasal mucosa. As a result of their swelling, the normal lumen of the nasal passages narrows, which leads to breathing difficulties.

With some types of runny nose, the venous plexuses become constantly overflowing with blood. This situation is possible when:

Allergic rhinitis.
Vasomotor rhinitis.
Drug-induced runny nose.

Nasal breathing in such conditions can be normalized using radical correction methods. Surgical intervention designed to reduce the volume of shells while maintaining their mucous membranes and shape.

Laser coagulation

With laser coagulation of the inferior turbinates, part of the mucous membranes in the nasal passages is destroyed by a special laser beam. It can act evenly over the entire affected area, leading to evaporation pathological cells. Laser destruction is a synonym for laser coagulation.

This therapy technique is used in cases where conservative treatment does not give the expected effect. Indications for its implementation:

Chronic form of rhinitis.
Proliferation (hypertrophy) of the nasal mucosa.
Long-term use of vasoconstrictor medications, without which free breathing becomes impossible.

A qualified otolaryngologist will help determine whether laser destruction of the inferior turbinates is necessary in a particular situation after conducting a detailed examination.

Contraindications

Like everyone else medical manipulations, laser coagulation of the inferior turbinates has certain limitations:

Presence of acute respiratory infections and other acute inflammatory diseases at the time of the intervention.
Purulent processes in the nasopharynx, oral cavity or paranasal sinuses nose
Having problems with blood clotting.
The period of bearing a child.
Presence of epilepsy.
Presence of a pacemaker.
The period of menstruation in the fair sex.
Presence of decompensated diabetes mellitus, suffered a heart attack or stroke.

How to prepare?

Before performing laser coagulation, the patient needs:

Pass general tests blood and urine.
Do an ECG.
Carry out other tests prescribed by your doctor.
Avoid taking medications that thin the blood.
Stop drinking alcoholic beverages.
Do not perform cosmetic procedures.
Do not use decorative cosmetics.

All restrictions must be observed for several days before laser destruction.

How is it carried out?

Immediately before laser coagulation, the patient:

Blood pressure readings are measured.
They talk about the features of the upcoming intervention.
They offer to change into disposable clothing - a robe with shoe covers and a cap.
They suggest going to the operating room.
Give sedatives if necessary.
They suggest lying on a couch, the head end of which is raised. It is important to take the most comfortable position possible.
A blindfold is put on the eyes, the limbs are fixed (if the patient does not mind), because any unexpected movements are fraught with burns.

Progress of the intervention:

The doctor introduces local anesthetic in the form of an injection or using turundas soaked in medicine (they are placed inside the nasal passages for a couple of minutes). Sometimes the painkiller is given as a spray.
The patient's face is treated with an antiseptic - 70% medical alcohol.
In order for the doctor to visually see the place where the condition of the nasal mucous membranes has deteriorated, they are stained with a solution of methylene blue. It is believed that such treatment can also improve laser performance.
After this, the doctor proceeds directly to destruction. To do this, he touches the problem area with a laser. Destructive processes are completely painless and allow you to preserve the integrity of the surface layers of the mucosa, as well as the cilia of the ciliated epithelium. The only thing unpleasant feeling that the patient may experience is a slight tingling sensation.
During surgery, the patient must breathe exclusively through the mouth. During laser coagulation, an unpleasant odor is heard.
The intervention is monitored using a special surgical mirror or endoscope.
After completion of treatment, the patient can go home within 1–2 hours.

In principle, laser destruction of the nasal turbinates is carried out in all clinics according to the same scheme. Only some differences in the work of a specialist are possible.

Advantages

Laser coagulation has a lot of advantages:

The operation lasts about ten minutes (rarely more), after which only small wounds of about one or two millimeters remain. Tissue damage is minimal.
There is no bleeding after surgery, so there is no need for nasal packing.
The patient needs to be in inpatient department about two hours, no more.
This intervention does not require hospitalization.
Postoperative wounds practically do not hurt.
Regeneration processes proceed at an accelerated rate.
The laser has sterilizing properties, which reduces the risk of postoperative complications.
The tissues heal completely, there are no rough scars left on them.
Therapy allows you to achieve a lasting therapeutic effect.

According to statistics, destruction of blood vessels with a laser can cure various types rhinitis and restore the activity of the nasal mucous membranes in 96% of cases.

Recovery

For successful rehabilitation after laser therapy the patient needs to follow a few simple recommendations:

Do not lead an active lifestyle, give up sports and bending for a while.
Not in heat, sauna, bathhouse, etc.
Stop drinking alcohol.
Do not use vasoconstrictors.
Use medications prescribed by a doctor (drugs that promote tissue regeneration, oils, etc.).

After laser coagulation of the turbinates, the patient’s ability to breathe through the nose returns after just three days.

Possible complications

Laser destruction extremely rarely causes complications, but can contribute to:

Disappearance or complete loss of sense of smell. This phenomenon is considered temporary.
Feeling of nasal congestion or breathing problems (possibly due to repeated hypertrophy or allergies).
Development of the inflammatory process.
Atrophy of the mucous membrane.

As a rule, laser destruction of the nasal turbinates occurs without complications and allows the patient to breathe fully through the nose again.