Surgery of Nasal Concha with Radio Frequency
Wolfhart König, MD
ENT community practice Wolfhart König, MD / Gertraud Maier, MD , Ettlingen, Germany
Case Study
ENT clients often claim about a malfunctioning nasal breathing. Besides it detracts
essentially the quality of life, it embeddes risks for the deeper respiratory systems,
due to the lacking of warming and humiliating of the breathing air and the not
filtered entry of volatile allergens.
A correction of malfunctioning nasal breathing reconstitutes a normal air supply and
enables the nose to fulfil its physiological duty again. Then the patient can breath
normally and the nose will regain its protectional function, e.g. against allergic
diathesis.
Improvement of nasal breathing at hyperplasia of the concha can be achieved by
medicamental and surgical treatment.
Mostly, the patients favor less interfering measurements which means that first the
conservative options will be utilized. If these therapeutical measurements do not lead
to a lasting abatement of discomforts a surgical concha reduction is indicated.
For surgical concha reduction a variety of different possibilities exists. They are
geared to the anatomical conditions (mucosal or os turbinal problems) of the patient,
the experiences of the surgeon and the instrumental equipment of the operation’s
location.
Performance of the Radio Frequency Surgery at Nasal
Conchas
This is a description of an easy applicable and complication low surgical treatment
with the method of radio frequency, especially suitable for a problem referring mainly
to the mucosa. It does not afford special experience of the surgeon and no timeconsuming protective measurements of the operation’s location or cost intensive
maintenance of the equipment.
Picture 1
The
bayonet
shaped
electrode is the most used one. The
cutting diamond electrode and the
cutting/coagulating blade electrode
are used for high geared mucosa
excesses.
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The surgery is performed under local anesthesia after the nasal concha’s swelling has
gone down. It can be conducted with a headlamp or under the microscope. Sterility
is not necessary. Therefore, it is suitable for an application on the therapeutical chair.
In our private practice, the operation is regulated that way that firstly a
sympathomimetic with local anesthetic additive as delegational help is sprayed into
the nose by the assistances. After the reaction time a further decongestant and
anesthetic cotton wool is inserted.
After the anesthesia, mostly the bayonet shaped electrode (picture 1) is inserted
horizontally in three different levels into the lower concha up to the os turbinal. The
application of radio frequency occurs for 10 seconds on each level. On the outside,
the mucosa then turns slightly pale (picture 2).
Picture 2 (operative situs)
Directly after application of radio frequency
intranasal on the left side, the mucosa turned
slightly pale. The three punctures can be seen as
little bleedings. Intranasal on the right side, a
status after application of radiofrequency three
weeks before can be seen.
Internally, the spreading of radio waves within the cells leads to a heat development,
the cell fluid expands and vaporizes simultaneously. The surrounding tissue does not
carbonize, explaining the low scabbing opposite to high frequency cauterization.
Furthermore, no necrosis with the risk of sequestration develops. Contrary to the use
of laser, the sub mucosal application achieves that the mucosa’s continuity stays
preserved.
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Further Postoperative Process
Following the surgery, a fibrinous sweating at the concha develops. Mostly, it
remains small and desiccates. Only in individual cases this leads to a noticeable
swelling, excretion of fibrin and developing of secretion for some days (picture 3).
Due to this reason, we are operating with local anesthetic but with a temporary
distance of three weeks. Only children who are treated with endotracheal anesthesia
will be surged simultaneously on both sides. Therefore, with local anesthesia
treatments a complete obstruction of the nose can be securely avoided for the
patient.
Picture 3
Nose conchas one week after treatment with radio frequency
Normal course with little developing of
scab
after
right-handed
radio
frequency therapy
An occasionally appearance of over
shooting reaction after simultaneous
treatment on both sides
Reasonable is a scheduled postoperative control at which single scabs can be
removed. Only in individual cases a wound control more often is necessary (picture
4).
Picture 4
Same patient as in picture
3, remaining coatings on both sides, 3
weeks after the treatment, with normal
nasal breathing
With high geared mucosa excess of the conchas it is possible primary to effect the
cutting/coagulating to the os turbinale and then to work more broadly with the blade
electrode (picture 1) within the region of the periosteum.
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Surgery with Radio Frequency
Surgery with radio frequency can not be compared to conventional high frequency
surgery. It does not only differ in a higher output frequency of 2.2 to 4.0 MHz
(contrary to 300 to 500 KHz at conventional high frequency units), but also in several
advantages, as there is lower heat development, better derivation, leaking voltage
peaks with sudden discharging and a lot more.
The electrode is the emitter of radio waves and during its activation it remains
always cold. Radio frequency waves are causing a sterilization effect to the tissue
which means on possible existing bacteria and viruses, too.
An antenna (panel) is the receiver of the emitter and leads the radio waves back into
the radio frequency system. It does not have to touch the skin, so it is not necessary
to undress the patient. Burns, feared by many colleagues, do not occur with radio
frequency.
Due to the high oscillation, very low depth effect and lateral heat is caused which
means that the surrounding tissue remains nearly cold. At coagulation the
broadening of the radio waves causes the development of heat within the cell
(approx. 50°C/122°F), the fluid of the cell vaporizes and expands. This leads to a
gentle thermal denaturizing of the surrounding tissue. Conditional on the
construction (smaller inductivities), there is no risk of arc loads. No carbonization of
the surrounding tissue will occur. According to its physical principle, the surgery with
radio frequency is comparable to a CO²-Laser but in its application as easy as high
frequency surgery.
Conclusion
Nasal conchas of adults can be surged under local anesthesia unproblematically and
without risk. The procedure is time efficient for the patient (loss of working time) and
for the doctor concerning application and economy.
Contrary to working with a laser, time-consuming protection measurements for the
patient, medical staff and doctor do not have to be taken. The unit which we used
(radioSurg® 2200, Meyer-Haake GmbH, Germany, picture 1) can be carried in a
bag and so it can be used in different places. There is no expensive maintenance.
The electrodes are autoclavable at least 75 times and, therefore, can be used nearly
without any costs.
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