Submucous diathermy (SMD) of Inferior Turbinates

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Diagram showing turbinate bones
There are three sets of turbinate bones in the nose. The inferior, middle and superior turbinates. Enlargement of the turbinate bones may a cause of nasal obstruction. 

Your doctor may suggest reduction of your turbinate bones to improve your nasal obstruction. 

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 minimised 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 moisturised 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.

Re-growth of turbinate tissue can gradually recur over months or years.

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Left image - Normal sized right enlarged right inferior, Right image - Inferior turbinate blocking airway
