Dr Paulose

SMD-Vasomotor, Chronic Hypertrophic Rhintis

There are 3 sets of turbinate bones inside the nose on the lateral wall. The inferior, middle and superior turbinates. Between the turbinates are the openings from the sinuses into the nasal passages.

The turbinates are covered in a special lining called mucosa. They increase the surface area of your nose lining. This helps to warm and moisten the air you breathe in through your nose.

Enlargement of the turbinate bones may a cause of nasal obstruction. The turbinates gets enlarged in allergic and vasomotor rhintis. Reduction of the turbinate bones helps to improve the nasal obstruction.

What is submucous diathermy

Diathermy is the use of high frequency electrical currents, during surgery. The electric current produces heat. It is sometimes called cautery.

The operation is carried out under a general anesthetic, usually as a day case procedure. This means that you come into hospital on the day of your operation and go home the same day

Submucous Diathermy (SMD) involves passing a probe just below the mucosal surface lining of the turbinate bones and cauterizing using heat energy to shrink the size of theses structures. This preserves most of the mucosal lining and allows for preservation of normal function. The mucosa humidifies and warms inspired air and also plays a role in the production and wafting of mucus to the back of the nose. The Inferior turbinates can in fact be completely removed in severe cases. Their function is then taken over by the other turbinate bones.

Depending on the procedure performed, the most common complications of turbinate surgery are bleeding and prolonged nasal dryness with crusting. Bleeding is minimized by careful surgical techniques and the use of packing. Postoperative trauma and dryness can lead to bleeding and so the patient is instructed to keep the nose well moisturized with the use of a saline nasal douche. Avoidance of nose blowing and opening of the mouth with sneezing are very helpful. No heavy lifting or straining is permitted for the first 2-3 weeks.

Doing all of the above and staying well hydrated can minimize crusting. Vaseline can be applied to the anterior nostrils for symptomatic relief at bedtime and throughout the day as needed. .

Reducing the lining of your nose will remove the blockage and improve your nasal breathing. It may reduce your risks of developing sinus infections.

A New Method

The SMD is usually performed by a special insulated monopolar diathermy probe with the naked tip causing the cautery. As the probe is fairly large in diameter and may not be able to pass into the entire submucosa without causing tear especially after applying vaso constrictor agents. It causes more damage and the area of diathermy is not controlled.

So what I have been using for many years is pass a spinal needle into the submucosa and touch the needle with monoploar cautery and gently withdraw while applying the cautery. Just be careful not to touch the nasal skin. This can be repeated at two or three points along the entire inferior turbinates without causing mucosal tear and get a very controlled diathermy.

Bleeding is minimal once the entry site is cauterized. Rarely need packing unless other procedure like septoplasty is done along with this.

(see gallery for more pictures)