Mucotomy – Inferior Turbinate Reduction Surgery
Mucotomy is an ENT operation aimed at reducing the volume of enlarged inferior nasal turbinates and improving breathing through the nose. The nasal turbinates are structures located along the lateral walls of the nasal cavity. Their mucous membrane helps warm, humidify and filter inhaled air. If the turbinates remain enlarged for a prolonged period, the nasal passages may become narrowed and cause persistent nasal obstruction. Mucotomy is most often considered when symptoms caused by enlarged turbinates persist despite appropriate medical treatment, for example treatment for rhinitis or allergies.
What are the nasal turbinates?
The nasal turbinates are mucosa-covered structures within the nasal cavity. They help warm, humidify and filter inhaled air and regulate airflow. Allergies, chronic irritation, infections or other causes may lead to swelling and enlargement of the inferior nasal turbinates. If the enlargement becomes persistent, it may significantly interfere with breathing through the nose.
When is mucotomy indicated?
Surgery may be considered in patients with chronic nasal obstruction caused by hypertrophy of the inferior nasal turbinates when conservative treatment has not provided sufficient improvement. Common symptoms and indications may include:
persistent difficulty breathing through the nose;
persistent or recurrent nasal obstruction;
markedly enlarged inferior nasal turbinates;
chronic or vasomotor rhinitis;
nasal obstruction caused by allergic rhinitis that responds insufficiently to treatment;
impaired nasal breathing at night;
mouth breathing;
snoring or sleep-disordered breathing when nasal obstruction is one of the contributing factors;
rhinitis medicamentosa in selected cases when conservative treatment has not been sufficient.
The decision to perform surgery is made by an otorhinolaryngologist (ENT specialist), taking into account the anatomy of the nose, the patient’s symptoms and previous treatment.
How is mucotomy performed?
During mucotomy, the doctor reduces the volume of the enlarged inferior turbinate tissue to create more space for airflow through the nasal passage. Depending on the patient’s anatomy and the chosen technique, turbinate volume may be reduced in different ways, for example:
using radiofrequency energy;
by coagulation;
using a laser;
by reducing tissue beneath the mucosa, known as submucosal reduction;
by partially reducing turbinate tissue surgically.
Modern techniques aim, as far as possible, to preserve the function of the nasal mucosa while reducing tissue volume. The operation may be performed under local or general anaesthesia, depending on the technique used, the extent of the procedure and the individual patient’s situation. Duration of the procedure: depends on the technique used and whether mucotomy is performed on its own or together with another nasal operation.
Mucotomy or septoplasty – what is the difference?
These are two different operations used to treat different causes of impaired nasal breathing.
Mucotomy
During mucotomy, the volume of enlarged inferior nasal turbinates is reduced.
Septoplasty
During septoplasty, a deviated nasal septum is corrected if it mechanically narrows the nasal passage and interferes with breathing. In the same patient, nasal obstruction may be caused by both a deviated nasal septum and enlarged turbinates. In such cases, the doctor may recommend performing both procedures during the same operation. During examination of the nose, other possible causes of obstruction should also be assessed.
Preparing for surgery
Before mucotomy, a consultation with an ENT specialist is required. The doctor assesses:
the duration and nature of the nasal breathing difficulties;
the size of the nasal turbinates;
the condition of the mucous membrane;
the anatomy of the nasal septum;
the possibility of allergies or chronic rhinitis;
previously used medical treatment;
other diseases of the nose and paranasal sinuses.
If necessary, nasal endoscopy may be performed to assess the nasal cavity and other possible causes of breathing difficulties in greater detail. If the operation is planned under general anaesthesia, the preoperative examinations prescribed by the doctor and anaesthetist must be completed beforehand. The patient receives individual instructions regarding the required laboratory tests, eating, drinking and the use of medicines before the procedure.
After mucotomy
During the first few days after surgery, the nose may be swollen and blocked, so breathing may not immediately feel easier than it did before the procedure. During the healing period, the following may occur:
nasal obstruction;
slight bleeding or blood-stained discharge;
nasal dryness;
crusting;
mild discomfort or sensitivity.
The doctor may recommend rinsing or moisturising the nose with saline solution and other measures that help the mucosa heal. Crusting after certain turbinate reduction techniques may persist for several weeks. After surgery, the doctor’s instructions regarding physical activity, nasal care and medication use should be followed.
When can the effect of mucotomy be expected?
Immediately after surgery, nasal breathing may be impaired because of postoperative swelling and crusting. As the tissues gradually heal and the volume of the inferior turbinates decreases, nasal breathing should improve. The final result is usually assessed after the healing period rather than during the first few days after surgery. The American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) also recommends assessing the airway outcome after more than one month.
Can the nasal turbinates enlarge again?
Yes. Mucotomy reduces the volume of the nasal turbinates but does not always eliminate the underlying cause of rhinitis or allergies. If chronic inflammation, allergies or other triggering factors persist, the mucosa may swell again over time and symptoms may recur. For this reason, continued treatment of rhinitis or allergies may also be required after surgery.
Possible risks and complications
Mucotomy is generally a minimally invasive ENT procedure, but as with any operation, risks are possible. These may include:
bleeding;
infection;
nasal dryness;
increased crusting;
scar tissue formation;
insufficient improvement in symptoms or recurrent nasal obstruction.
Long-term complications following turbinate surgery may also include pronounced dryness or atrophic changes of the nasal mucosa. For this reason, the extent of surgery is selected so as to preserve the physiological function of the turbinates as much as possible. If severe bleeding, difficulty breathing, high fever or a significant deterioration in general well-being occurs after surgery, the patient should contact the medical facility or seek urgent medical attention.
