Conchotomy

CONCHOTOMY (from the Greek conche—shell and temno—to cut), the removal or resection of the nasal turbinates. The inferior or middle turbinate is removed partially or entirely. Either only the soft parts are subjected to surgical intervention, or the latter are resected together with the bony skeleton of the turbinates. Resection of the inferior turbinate in the soft parts is performed for pronounced hypertrophic rhinitis. In these cases, the turbinate usually appears as diffuse or localized lobular formations, which occupy the greater part of the inferior and part of the middle nasal meatus and, due to the disappearance of the cavernous tissue in the thickness of the mucosa, hardly decrease in size when swabbed with cocaine. Depending on the location of the growths, a posterior or anterior conchotomy is performed. In cases of less pronounced hypertrophy, conchotomy is successfully replaced by galvanocautery of the inferior turbinate. Removal of the inferior turbinate with the bony skeleton is performed only under special indications, e.g., in case of its abnormally large size, in case of narrow nasal passages, when it is necessary to obtain wide access to the deeper parts of the nose during diseases of the accessory sinuses, etc. Removal of the entire turbinate with the bone leads to the development of an atrophic process in the mucosa of the nose and pharynx with the formation of crusts, dryness, and other distressing symptoms.

Removal of the middle turbinate is also partial or total. Most often, it is necessary to resect its anterior end, because an enlarged middle turbinate closes the middle nasal meatus and serves as an obstacle to the drainage of discharge from the ethmoid cells, from the frontal sinus, and from the maxillary sinus. This intranasal intervention is of very great importance in the treatment of accessory nasal sinuses in chronic cases, as it is a preliminary stage for further surgical interventions. The posterior end of the middle turbinate is removed for access to the sphenoid sinus and to the posterior ethmoid cells. The turbinate is removed together with the bony skeleton and often simultaneously with the opening of the ethmoid labyrinth.

Removal of hypertrophied anterior and posterior ends of the inferior turbinate is performed with a cold or hot galvanocautery snare. Diffuse hypertrophies are removed with special Beckman scissors (see figure). The nasal snare is inserted into the nose under visual guidance and is placed on the thickening as close to the base as possible; upon tightening

the turbinate is cut off. If the oper-

ation is performed with scissors,

then they are positioned in the nose

so that one blade is placed under

the inferior turbinate, and the other lies on its medial surface. When closing the scissors with a cutting motion, they are advanced posteriorly. If the posterior end has not been caught in the incision, the operation is completed by applying a snare, or it is bitten off with a conchotome by Hartmann, Grünwald, and other authors. The middle turbinate is removed with a cold snare after preliminary incision of its base with Beckman scissors, or it is destroyed with a conchotome. Operations are performed under local anesthesia with a 10% cocaine solution; to avoid strong tissue contraction, it is not recommended to swab the inferior turbinate with adrenaline. Bleeding during the operation is for the most part insignificant and is easily stopped with a gauze tampon, which can be kept in the nose for 1-2 days. When removing the posterior end of the inferior turbinate, one must always be prepared to perform posterior tamponade, especially since bleeding can sometimes occur several days after the operation. It is dangerous to operate on both sides simultaneously. The postoperative course is for the most part smooth, and healing occurs faster than after cauterization. The wound does not require special care. Contraindications to the operation are hemophilia and debilitating general diseases.