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.
1. 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
2. Turvey, TA. Management of the nasal apparatus in maxillary surgery. J Oral Surg. 1980 May; 38(5): 331-5