Current Concepts in Laser Surgery: Endonasal Laser Turbinate Reduction

Inferior turbinate hypertrophy is a common cause of nasal airway obstruction. Whilst the initial mainstay of treatment for this condition is with the use of pharmacologic therapy such as steroids and antihistamines, there remains a considerable cohort of patients that are refractory to this treatment and require surgery. Numerous surgical techniques for inferior turbinate hypertrophy have been employed over the years, including total or partial turbinectomy, turbinoplasty (submucous resection, microdebrider, conchopexy, outfracture), laser surgery, and thermal techniques (electrocautery, cryosurgery, radiofrequency ablation) [1]. Techniques aiming at removal of most of the turbinate tissue including bony structures seem to provide the most distinct and long-lasting effects, but are also accompanied by higher morbidity [2]. Besides intra- and postoperative bleeding, adverse side effects observed include synechiae, nasal dryness and crusting, osteitis, foetor, atrophic rhinitis, etc. There is a general trend in the last decades leading toward mucosal sparing/tissue sparing techniques and steering away from extensive mucosal destruction (e.g., turbinectomy) as the latter modes of turbinate reduction are thought to be most associated with the mentioned secondary effects including empty nose syndrome [3–5]. Since the introduction of laser technology in the field, it has been demonstrated in numerous clinical studies that endonasal laser treatments cause limited tissue trauma with little or no bleeding and reach a high patient acceptance as they can be usually performed without nasal packing and under outpatient conditions [6].