Argon Plasma Surgery for Treatment of Inferior Turbinate Hypertrophy: A Long-Term Follow-Up in 157 Patients

Abstract

Chronic nasal obstruction is a common disorder, mostly caused by hypertrophic inferior turbinates. In cases of nonresponse to conservative medical management, the surgical reduction of the inferior turbinates is often required. Surgical techniques for the reduction of hyperplastic nasal turbinates include monopolar or bipolar coagulation, partial or total reduction of the turbinates with a conchotome or scissors and laser surgery with Nd:YAG, CO₂ or KTP. Argon plasma coagulation (APC) is a new, innovative technique in otorhinolaryngology which is based on high-frequency electrocoagulation with an argon gas source. The fast and short surgery times, the absence of hemorrhagic complications and, in rhinosurgery, the complete abstention from any kind of nasal packing are remarkable. Between March and November 2000, a group of 157 patients with symptoms of nasal obstruction due to hypertrophic inferior turbinates were treated using APC, at the Otorhinolaryngology Surgery Department of the Hospital of Dolo (Venice). The follow-up period was 24 months. Rhinomanometry was performed to objectively measure the nasal obstruction and to verify the postoperative improvement. The Student t test was used for statistical data. After 24 months, 87% (p < 0.001) of the patients reported to have a better nasal airflow than before the operation. None of the patients needed a nasal packing after APC surgery. The indication, advantages, complications, controversies and long-term results of the treatment with APC in rhinosurgery are reviewed and discussed.

The evidence for reducing inferior turbinates

“…Ferri and colleagues followed up 157 patients treated with Argon plasma surgery for turbinate hypertrophy. After 24 months 87% of patients reported improved nasal airflow as compared to preoperatively (64) . To reduce mucosal damage Supiyaphun and colleagues used an 18-gauge needle to introduce an optical fibre into the inferior turbinate.…”

Coagulative and ablative characteristics of a novel diode laser system (1470nm) for endonasal applications

“…For the 940 nm system (as well as the Ho:YAG laser system), however, a previous study has shown promising long term results for this indication [10]. Due to the small patient numbers and the lack of long term data, it is furthermore not feasible to directly compare the method to other novel approaches for a reduction of turbinate volumes in nasal congestive disease such as alternative laser systems, argon plasma coagulation or radiofrequency surgery, which have also been reported to provide satisfying results [1,2,3,8,11,12]. Due to the observations made in the in vitro experiments, it may be expected that the new 1470 nm diode laser system should also (and apart from its coagulative capabilities) dispose of excellent tissue cutting abilities in contact mode due to the high rate of tissue ablation.…”

Turbinate Surgery in Chronic Rhinosinusitis: Techniques and Ultrastructural Outcomes

“…Argon plasma coagulation (APC) originally has been used on gastrointestinal lesions under endoscopy then it has been introduced into otolaryngological field [42]. In this method, the current flow is conducted through ionized argon gas (socalled plasma) [43].…”