Does Total Inferior and Middle Turbinectomy Always Lead to Empty Nose Syndrome?

Abstract

Empty Nose Syndrome (ENS) is a rare and paradoxical complication often associated with aggressive turbinate reductions. Previous computational fluid dynamic (CFD) modeling has indicated that distorted nasal airflow patterns could contribute to ENS. However, no data have shown that aggressive turbinate reductions consistently lead to ENS. Retrospective case series. Tertiary. We retrospectively recruited 6 nasal obstruction patients who underwent turbinate reduction surgery, and performed total inferior and middle turbinectomies on all patients using a published virtual surgical simulator. We compared the CFD modeling results to that of patients' presurgery and postsurgery and published 27 ENS patients. As expected, the virtual turbinectomy significantly expanded nasal airway cross-sectional area, more than that of actual surgery (inferior: 0.9 ± 0.4 to1.8 ± 0.3 cm², middle: 0.6 ± 0.3 to 1.0 ± 0.3 cm², all P < .01); however, it does not create the same distorted nasal airflow patterns as seen in ENS patients, with no significant difference in nasal resistance after actual surgery (0.12 ± 0.04 Pa/mL*s) versus virtual surgery (0.10 ± 0.03 Pa/mL*s) nor ENS (0.11 ± 0.04 Pa/mL*s, all P > .05). However, all had significantly higher inferior wall shear force (WSF) distribution, an important indicator of air/mucosa stimulation, than that of ENS patients (baseline 54.0 ± 11.9%, surgery: 51.5 ± 15.1%; virtual: 46.5 ± 11.5%, P > .05; ENS: 32.2% ± 12.5%, P < .001). The opposite was seen for the middle turbinate region-WSF among all actual or virtual surgeries conditions was significantly lower than that of the ENS group (baseline: 36.1 ± 11.0%; virtual: 30.2 ± 13.1%; ENS: 43.8 ± 10.1%; all P ≤ .05). ENS cannot be solely attributed to aggressive turbinate reduction surgeries with various factors potentially playing a role.