Submucosal Resection (SMR) of the Inferior Turbinate
The turbinates (inferior, middle and superior) consist of three boney shelves positioned along the side wall of the nasal cavity. The turbinates function to humidify and warm air as it passes through the nose en route to the lungs. In addition, the turbinates are the primary regulators of nasal resistance. Throughout the day the turbinates swell and shrink through a process known as the nasal cycle. Patients often notice that one side of the nose is congested and several hours later the congestion shifts to the other side – this is the nasal cycle. The inferior turbinate is the largest of the three turbinates and is responsible for the nasal cycle. Congestion during a cold, allergy attack, or congestion at night are all due to inferior turbinate swelling.
The objective of SMR of the inferior turbinates is to remove the soft, spongy inner core of the turbinate while preserving the pink lining (mucosa). I liken SMR to liposuction as they are performed in a similar fashion. The procedure is performed in the office under light oral sedation or in the operating room. Oral sedation consists of valium 1 hour before the procedure and again at the beginning of the procedure. A small endoscope attached to a camera a video system provides excellent visualization. Local anesthesia is provided by application of a topical gel with cotton pledgets followed by injection of lidocaine – similar to a dental procedure. A suction device is then used to remove the spongy inner core of the inferior turbinate. Bleeding is very minimal and nasal packing is not expected.
Recovery following SMR is mild. Patients can return to work the next day. I do not advise significant exercise or straining for 1 week. Pain is typically be managed with Tylenol or Ibuprofen alone. Saline (salt water) rinses are recommended several times a day for weeks to alleviate minor crusting at the incision site. I routinely see patients back 1-2 weeks after the procedure to inspect the nose and remove residual crusts.