Hypertrophic Turbinates in the Orthognathic Surgery Patient

In this study Dr. Wolford discusses how careful presurgical evaluation, not only of the skeletal deformity, but also of functional airway problems is important. In this study, there was a high prevalence of hypertrophic turbinate’s in patients with A-P hypoplastic maxilla and mandible with high occlusal plane angle. Partial inferior turbinectomies is a safe and predictable procedure that can be easily performed in conjunction with LeFort I osteotomies.

Hypertrophic Turbinates: Prevalence, Surgical Indications And Outcomes in the Orthognathic Surgery Patient

By Carlos A. Morales-Ryan, DDS, MSD, Larry M. Wolford, DMD

Purpose:
Evaluate the prevalence of hypertrophic turbinate’s in orthognathic surgery patients; establish a possible trend for specific patient skeletal profile; and report outcomes of partial turbinectomies and LeFort I osteotomy.

Patients and Methods:
Records of 591 consecutive patients who had maxillary orthognathic surgery from a single practice were retrospectively evaluated. Diagnostic criteria for hypertrophic turbinate’s included:

  1. history of consistent difficult breathing through nose;
  2. clinical and radiographic evidence of the turbinate’s blocking the majority of the nasal airway;
  3. predominantly mouth-breathing particularly when sleeping. Evaluations included: Medical history; clinical assessment; standardized x-rays (lateral cephalogram, panograph, Waters view); A-P and vertical position, and transverse dimension of the maxilla and mandible, and occlusal plane angulation as determined from lateral cephalograms and dental models; External and internal nasal deformities; and current respiratory problems. Surgical outcomes and complications were recorded.

Descriptive statistics and Pearson’s Correlation Analysis were utilized to evaluate the results.

Results:
Hypertrophic turbinate’s were present in 236 of 591 patients (39.9%). All 236 patients presented moderate to severe hypertrophic turbinate’s and partial nasal airway obstruction. Sex distribution was 136 females (57.6%) and 100 males (42.4%). Mean age was 28 years (13 to 58). Bilateral partial turbinectomies were performed simultaneously with LeFort I osteotomies, resecting 2/3 to 3/4 of each turbinate. Surgical sites were cauterized. In addition, 60 patients (25.4%) had external rhinoplasty and 159 patients (67.4%) had nasal septoplasty. The occurrence rates of hypertrophic turbinate’s relative to deformity type were:

  1. maxillary hypoplasia A-P (82.2%), vertical (45.3%) and transverse (52.5%);
  2. mandible hypoplasia A-P (70.3%), normal vertical (94.9%) and normal transverse (97.9%), and
  3. high occlusal plane angle (60.2%). A skeletal profile was identified: Maxillary and mandibular A-P hypoplasia showed a strong correlation (R=0.95; p<0.05); and high occlusal plane angle showed a moderate to strong correlation (R≥0.81; p<0.05).

All patients reported improved breathing at longest follow-up. The most common postoperative sequelae were mild increased bleeding from the turbinate surgical sites immediately post-surgery as compared to orthognathic surgery patients without turbinectomies. No other known complications occurred.

Occurrence of Hypertrophic Turbinate’s Relative to Type of Dentofacial Deformity

Conclusions:
Careful presurgical evaluation, not only of the skeletal deformity, but also of functional airway problems is important. In this study, there was a high prevalence of hypertrophic turbinate’s in patients with A-P hypoplastic maxilla and mandible with high occlusal plane angle. Partial inferior turbinectomies is a safe and predictable procedure that can be easily performed in conjunction with LeFort I osteotomies.

References:

  • Bell, WH., Sinn, DP. Turbinectomy to facilitate superior movement of the maxilla by Le Fort I osteotomy. J Oral Surg. 1979 Feb; 37(2): 129-30
  • Turvey, TA. Management of the nasal apparatus in maxillary surgery. J Oral Surg. 1980 May; 38(5): 331-5