Nasal concha reduction, lower nasal concha reduction surgery (mucotomy)
Opposite the nasal septum, there are 3-3 horizontally running formulas on the side wall of the nasal cavity, the so-called nasal concha. The width of the nasal cavity, normal nasal breathing basically depends on the shape of the nasal septum and the size of the nasal concha (especially the lower nasal conchae). In addition to nasal breathing, the nasal concha is responsible for filtering, heating, and humidifying the air. The most common cause of nasal congestion, in addition to nasal septum deviation, is the swelling of the lower nasal concha, which in many cases occurs together and this also explains bilateral, often alternating side nasal congestion. It is less common for the “bullous” middle nasal concha to be enlarged, the reduction of which is performed within the framework of FESS surgery.
The most common causes of lower nasal concha enlargement are: prolonged use of “conventional” nasal drops/spray, allergic rhinitis, chronic non-allergic rhinitis, drug side effects, nasal septum deviation, reflux disease, pregnancy.
Why is nasal concha surgery needed?
Surgery is recommended in case of patients who do not respond to conservative treatment (e.g. steroid nasal spray) when swelling of the lower nasal concha is present alone or is part of the causes that cause and maintain inhibited nasal breathing (e.g. nasal septum deviation, nasal polyps). Surgery may be used to ensure better nasal breathing or to correct the secondary consequences of nasal breathing: prolonged upper and lower respiratory tract infections, sinusitis, chronic throat and pharyngeal disorders, auditory tube dysfunction, otitis media, headache, acute and chronic ear infections, snoring, sleeping disorders, (e.g. OSAS).
How does the procedure work?
Lower nasal concha reduction surgery is a simple procedure that is recommended with local anaesthesia, but of course general anaesthesia is also possible. There are several methods for reducing the lowering the nasal concha, in our hospital we prefer radiofrequency and coblation surgery.
With the coblator technology, a focused plasma allows precise removal of tissues at low temperatures (40-70 °C), resulting in smoother anatomical surfaces and reducing the thermal load on surrounding tissues compared to conventional monopolar diathermy devices or mechanical cutting devices.
It is also possible to reduce the nasal concha with laser, conventional method, scissors and electrocautery. A common feature of all methods is that they result in the reduction of the lower nasal concha during or after the surgery.
The length of the surgery, depending on the type of anaesthesia (general/local), is approx. 15-30 minutes.
Tamponing of the nasal cavity is rarely necessary (especially after the “scissor” method). In case of tamponing, the tampon is removed on the first day after surgery.
What are the advantages and risks of the surgery?
The advantage of the operation is the improvement of nasal breathing, which also has a positive effect on daytime activity and restful sleep at night. In cases where the inhibited nasal breathing already causes secondary diseases of the paranasal sinuses, ears, pharynx, larynx and lower respiratory tract, sleep disorders, the surgery also helps with these.
Nasal concha reduction surgery is a common and safe procedure, side effects are rare. As with any surgical procedure, there are risks, primarily bleeding, less commonly infection. It is important that in case of severe nosebleeds, weakness, severe headache unresponsive to analgesics, high fever, an examination is required immediately at our Hospital or the regionally competent otolaryngology department. In this case, call our case manager.
Before the operation, you will receive an information sheet and a statement of consent, which contains detailed information about the nasal concha surgery, its risks, information before and after the procedure, and what to do. In all cases, it is possible to discuss the possible risks of surgery with your doctor before deciding on treatment.
There are also risk factors associated with anaesthesia, for which we provide a separate information sheet and a statement of consent. Mandatory preoperative examinations ensure that the risk is minimized.
Am I fit for surgery?
The need for surgery is decided and recommended based on the otolaryngology examination performed in our hospital and medical history. Our otolaryngologist uses a nasal speculum and endoscope to examine your nose, check the shape of the nasal septum, the size of the nasal conchae, and see if there are any other abnormalities (polyps, hypertrophic tonsil, rarely a tumour). The final diagnosis is made based on a physical examination and a CT scan of the nasal and paranasal sinuses. Allergy testing is also performed for signs of allergy. Suitability for anaesthetic surgery is decided by our anaesthesiologist or, if necessary, and internist, based on a blood count, ECG examination and chest X-ray.
How do I prepare for surgery?
Before the nasal concha surgery, bring your previous final reports for pre-surgery examination and consultations, make a list of your regular medications, vitamins, dietary supplements, other health problems, previous illnesses, drug sensitivities and allergies, and possible diet.
You will find all the necessary information about the operation in the surgical and anaesthetic patient information and consent form received in person or by e-mail before the operation, please read it, sign it, give it to the anaesthesiologist and bring it for the operation!
What should I do after a mucotomy?
In the days after surgery, severe nasal congestion is common, serous-mucous, rarely bloody discharge may leak from the nasal cavity for a week or two, or the discharge may harden in the nasal cavity in the form of scale. To soften it, we usually suggest useing a nasal ointment, nasal oil or we recommend using a nasal wash set. A health conscious lifestyle for two weeks after the surgery is warranted, you can undertake a lot of physical exertion and intense sports after a month. It is recommended to drink plenty of fluids, dietary restrictions or diet is not necessary, alcohol consumption and smoking are prohibited for 1 month after surgery. In case of bleeding, swelling of the face and head, persistent headache, dizziness, high fever, immediate follow up examination is recommended.
Why are postoperative follow-up examinations important?
The first follow-up examination after nasal concha reduction surgery is due one week later, when nasal cleansing treatment is required to avoid the development of infections and adhesions, during which the detached parts of the nasal concha and the scales are removed. Follow-up examinations are usually required 2-3 times within 1 month after surgery. It takes 3-10 weeks for the nasal concha to heal, depending on the method of surgery, which is indicated by the cessation of scarring and an improvement in nasal breathing.
We accommodate our clients in a modern, pleasant, air-conditioned single room. Each room has a private bathroom, fridge and TV, and free WIFI access. We also provide our clients with individual nurse supervision, who will help your continuous recovery during your stay.