Inferior turbinate hypertrophy (ITH) is a common cause of nasal obstruction, which causes noticeable patient discomfort. The purpose of turbinate surgery is to regain adequate space inside the nasal cavity for patients to breathe through the nose without loss of nasal function. Preserving the functional inferior turbinate (IT) mucosa is important to avoid the risk of dry throat, nasal crusting, and an overly patent nasal cavity (1).

Numerous surgical techniques for ITH have been reported (2). Submucosal resection is one of the best options for ITH in reducing the bony component of the IT without severe complications. A large incision, however, is often necessary to remove the inferior turbinate bone (ITB) during submucosal inferior turbinoplasty (SIT), which is associated with hemorrhage, crust formation, and adhesion. A small incision is necessary to reduce such complications, but it reduces the surgical field of view. Hence, a new surgical procedure with a smaller incision is needed that maintains a clear surgical view in this very narrow space. Using a continuous suction irrigation method enabled us to obtain a clear surgical view and still perform fine manipulations including hemostasis and bone removal. We performed this method in 39 cases from January 2016 to January 2017 without experiencing severe complications. This video article demonstrates our new continuous suction irrigation method for SIT.

The ITB was resected without severe complications including hemorrhage, crust formation, adhesion, or loss of nasal function. To determine the effectiveness of this method, we compared areas of the common nasal meatus using computed tomography (SYNAPSE; Fujifilm, Tokyo, Japan) preoperatively and 3 months after surgery. The three areas that were measured were level areas of the anterior, middle, and posterior IT (Table 1). An expanded area of bilateral common nasal meatus accompanied by lateralization of the IT was confirmed by computed tomography (Figure 5).

Submucosal inferior turbinoplasty is one of the best surgical options to reduce IT volume. Recently, pyriform turbinoplasty and medial flap inferior turbinoplasty have been reported (4, 5). These techniques are useful for improving nasal patency; however, they can be associated with hemorrhage, curst formation, and adhesion because of the large surgical wound. We believe that our method improves on other techniques because it minimizes the size of the surgical wound, preserves almost all of the IT mucosa, allows hemostasis by providing access to the branch of the sphenopalatine artery, and permits fine surgical maneuvers.

This continuous suction irrigation method has several limitations. First, the surgeon must be highly skilled in endoscopic nasal surgery. To perform fine surgical maneuvers underwater, surgeons must perform fine manipulations in the narrow nasal space, which resembles a small pocket, while avoiding tears in the IT mucosa. Second, SIT may lead to atrophic rhinitis; however, this complication has not been reported in two articles evaluating the long-term results of SIT (6, 7). Similarly, we have not experienced atrophic rhinitis in our cases. We believe that preserving the IT mucoperiosteum is particularly important to avoid atrophic rhinitis after SIT, and the mucoperiosteum is readily preserved using our continuous suction irrigation method. Third, the follow-up period in our study was short. Therefore, longer follow-up periods are needed to determine the value of this method.

The clear surgical view provided by our continuous suction irrigation method allows SIT to be performed safely and reduces the risk of complications, including those caused by hemorrhage during SIT. We believe that our continuous suction irrigation method may be useful not only for SIT but also for other endoscopic nasal surgery.

This surgical method was in accordance with the Ethical Guidelines for Medical and Health Research Involving Human Subjects issued by the Ministry of Health, Labor and Welfare in Japan. The institutional ethics committee in Kosei Hospital approved the method. Written informed consent was gained prior to surgery from the participants.

TK was the major contributor to writing the manuscript. NK contributed to writing and correcting the manuscript. All authors read approved the final manuscript.

The authors declare that the study was conducted in the absence of any commercial or financial relationships that could be constructed as a potential conflict of interest.