The upper, middle and lower turbinates are normal structures in the nasal cavity. Once the turbinate mucosa is stimulated by chronic inflammation to produce hyperplasia and hypertrophy, it will lead to nasal congestion in patients, which is clinically called chronic hypertrophic rhinitis. This is a common and frequent disease, in addition to causing nasal congestion in severe cases, it can also cause headaches and affect sleep, leading to mental depression during the day and affecting their quality of life. Due to the ineffectiveness of drug treatment for this disease, surgical treatment is adopted in clinical practice. Inferior turbinate hypertrophy is the main cause of nasal congestion, so the aim of various surgical procedures is to reduce the volume of the hypertrophied inferior turbinate. Traditional surgical methods include partial or total inferior turbinate excision, submucosal inferior turbinate excision, and partial inferior turbinate excision with suction-cutting drill. These procedures are more invasive and bleed more, thus the nasal cavity needs to be filled with oil gauze for 48 hours after surgery to stop the bleeding, which is very painful for patients. Laser, microwave, electrocoagulation and other inferior turbinate surgeries cause serious thermal damage to the nasal mucosa due to their high treatment temperature, resulting in postoperative nasal mucosal edema, nasal blockage and even nasal adhesions. Recently, our department has carried out plasma inferior turbinate ablation to treat chronic hypertrophic rhinitis, and hundreds of cases have been treated with very satisfactory results.
We use the bipolar low temperature plasma radiofrequency ablation system (ArthroCare, USA). The working principle is that the electric current forms a thin layer of low temperature plasma between the bipolar RF fields, and the charged particles in the thin layer have enough kinetic energy to break the molecular bonds of tissues, which can decompose and vaporize the tissues at a low temperature of 40-700C, producing real-time, efficient and precise cutting and ablation effects. Because of the high efficiency of ablation, the duration of action in the tissue is only 10 to 15 seconds, which increases the patient’s tolerance of this treatment.
The procedure is very simple and the patient requires only surface anesthesia. The system is connected to a long needle-shaped special blade, which is inserted under the mucosa of the hypertrophied inferior turbinate and ablated or coagulated with the foot control pedal. 1 channel is ablated in 10 seconds. The operation time is very short because 4-6 channels can be ablated on each side of the inferior turbinate. There is no bleeding during and after the procedure, no need for nasal tamponade, no pain for the patient, and no need for special care, so there is no need for hospitalization. Because of the low working temperature of 40-700C, plasma inferior turbinate ablation is light on the nasal mucosa and effectively treats nasal congestion while preserving the function of the nasal mucosa and glands as much as possible, which is unmatched by previous surgical procedures. According to the results of our prospective subgroup trial, the efficacy of plasma inferior turbinate ablation was comparable to that of partial inferior turbinate resection by suction excision drilling at 6 months of follow-up.
In conclusion, plasma inferior turbinate ablation is easy to perform and can be performed under local anesthesia in an outpatient setting. The development of plasma inferior turbinate ablation has brought gospel to the majority of nasal blockage patients.