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Medical Forum / Diseases and Disorders / Sinusitis / August 2004plastic vs ENT surgical approaches for turbinates
I met with a fairly prominent local facial plastic surgeon yesterday (through UCSF) about my nasal obstruction. He wants to correct the deviated septum, put in alar batten grafts, and "reposition" the turbinates. It's not a submucous resection or partial turbinectomy, but a vaguely classifiable procedure (turbinoplasty?) that does an outfracture of the bone and then moves the turbinates. No tissue is removed. Any opinions on this plastic surgery approach relative to the standard ENT approach of SMR/partial turbinectomy? I'm wondering if it will even do much of anything... he said it's very conservative and that the risk was skewed toward the surgery being ineffective rather than excessive. Like all nasal procedures, there are no longitudinal studies exceeding 5 years or so, which doesn't help me much. Thanks, Brian I think I would only go to a surgeon that has performed hundreds if not thousands of surgeries in the sinus. The danger of optic nerve damage and brain leakage makes me nervous even will some of the best this country has to offer. I would check with the plastic surgeon to see how many of these he has done and his success rate. Just my .02 worth. Trudy. >I met with a fairly prominent local facial plastic surgeon yesterday >(through UCSF) about my nasal obstruction. He wants to correct the [quoted text clipped - 12 lines] >Like all nasal procedures, there are no longitudinal studies exceeding >5 years or so, which doesn't help me much. Personally I would want ENT work done by an experienced sinus surgeon only. Why did you even see a plastic surgeon? Are there esthetic aspects to this? My ENT at UCSF referred me to him... this is through UC-SF, which is one of the top 10 ENT clinics so it's hard to be too skeptical. The ENT thought batten grafts would be useful to help combat the valve collapse (structural flaw) in my nose, and that's where the expertise of a plastic surgeon helps. There is nothing cosmetic about this. The plastic surgeon has done tons of nasal obstruction work. The more I learn, the more I've come to understand that plastic surgery on the nose is often for a combination of functional and aesthetic reasons, so for my functional problem I'm open to it. My concern is that "repositioning" the turbinates is too conservative. My research has led me to believe that endoscopic use of a microdebrider to remove some submucosal tissue is the best method, but it sounds like he just does an outfracture. > >I met with a fairly prominent local facial plastic surgeon yesterday > >(through UCSF) about my nasal obstruction. He wants to correct the [quoted text clipped - 16 lines] > > Why did you even see a plastic surgeon? Are there esthetic aspects to this? >My ENT at UCSF referred me to him... this is through UC-SF, which is >one of the top 10 ENT clinics so it's hard to be too skeptical. The [quoted text clipped - 5 lines] >nose is often for a combination of functional and aesthetic reasons, >so for my functional problem I'm open to it. Oh ok. I would be cautious all the same. I would get some second opinions personally. One can't afford to be a guinea pig for new theories. You will find that there are all sorts of schools of thought as to the best way to treat any given situation. Now, maybe it is all well established and A-OK, but I would just want to be sure. >My concern is that "repositioning" the turbinates is too conservative. > My research has led me to believe that endoscopic use of a >microdebrider to remove some submucosal tissue is the best method, but >it sounds like he just does an outfracture. I have to disagree about seeking other methods. Inserting battens to support a collapsing nasal border is standard stuff and gettng other opinions is a waste of time and money.. The sides of the nose collapse on inhallation. So you place battens. Not a rocket science. Murray Grossan, M.D. http://www.ent-consult.com > Inserting battens to support a >collapsing nasal border is standard stuff and gettng other opinions is a waste >of time and money.. The sides of the nose collapse on inhallation. So you place >battens. Not a rocket science. I stand corrected then. Sorry for the error. So it is not at all odd to refer that out to a plastic sugeon rather than having it done by an ENT? |
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