What is Turbinate Reduction?Designed and Developed by Donald P. Dennis, M.D The Dennis Bipolar Turbinate Probe for Turbinate Surgery was designed to perform bipolar submucosal coagulation of the inferior one-half of the inferior turbinate longitudinally.
Description of Design (probe for turbinate surgery )The probe design includes a pencil grip for easy handling with a bayonet needle mount for easy intranasal visualization during surgery with parallel 4 cm needles affixed 3 mm apart for precision tissue destruction.
Surgical Technique of Turbinate SurgeryFive- percent topical cocaine pledgers are placed in the nose for approximately five minutes and then withdrawn. The turbinates are injected each with 2 cc of two percent xylocaine with 1:100,000 epinephrine. This allows some hydrodissection of the turbinate tissue from the turbinate bone and the added submucosal fluid protects against cautery bony necrosis (if the patient has a history of cardiac problems, plain two percent xylocaine is used). The needles are placed in the inferior one-half of the inferior turbinate approximately 2 mm into the turbinate tissue and a test dose of current is given to be sure the machine is working properly and that current is being delivered properly. The Elmed Generator setting is approximately four. After the correct setting is established with a test dose, the needles are then inserted the full length of the turbinate submucosally in the inferior one-half of the inferior turbinate longitudinally. One to two second spurts of electrical current are used until visualblanching occurs. After blanching occurs, the probes are removed. The same procedure is performed on both sides and the patient is dismissed to return to work. The nose opens immediately and in many cases, the postoperative edema is not enough to completely obstruct the airway again.
The patient is allowed to blow both nostrils gently: Saline irrigation with one quarter teaspoon salt in a six ounce glass of water with an ear bulb syringe twice a day has been found to be very helpful in keeping crusting to a minimum. The patient returns to the office in two weeks when the final crust can be removed, provided the turbinates have not been too vigorously coagulated. Initially an approximately 3% postoperative bleeding rate was observed at a two to three week interval. This was easily stopped with cotton balls saturated with Afrin nose drops and external pressure applied. This was associated with too vigorous turbinate coagulation in all cases; therefore, it is strongly recommended that coagulation be discontinued immediately after blanching is observed.
Advantages of the Dennis Probe in the Treatment of Chronic Obstructive Turbinate Hypertrophy
- It can be used in the office with local anesthesia
There is no intraoperative or postoperative pain
There is no packing necessary
The patient may return to work the same day
The high cost of hospitalization and anesthesia is avoided
The method is reliable
It gives precision tissue coagulation
It may be repeated in the office in ten minutes if necessary; however, the author has not found it necessary to date
The bayonet mount allows good visualization during surgery with precision handling
It is safe and effective in children with chronic obstructive turbinate hypertrophy and chronic rhinorrhea.