OPERATIONS UPON THE INFERIOR TURBINAL
Amputation of the anterior end. Indications. The amputation may be required:
(i) On account of polypoid degeneration of the anterior extremity of the turbinal.
(ii) To allow of access to the antro-nasal wall (see [p. 633]).
(iii) To avoid operation on the septum by relieving nasal stenosis.
Fig. 289. First Step in removing the Anterior End of the Inferior Turbinal, which is seen to have undergone Polypoid Degeneration.
Operation. The local application of cocaine and adrenalin (see [p. 573]) is sufficient.
Anæsthesia. With the patient sitting upright in a chair, and the nostril well illuminated, a pair of nasal scissors (such as Heymann’s, Walsham’s, or Beckmann’s) are made to grasp as much of the anterior extremity as it is desired to remove, generally the anterior third (Fig. 289). The scissors are pressed very firmly against the outer nasal wall, so as to divide the base of the turbinal as close as possible to its attachment. If the scissors slip off the bone it should be divided with Grünwald’s punch-forceps. The semi-detached extremity is then surrounded with a nasal snare, carrying a No. 5 piano wire, and cut through ([Fig. 291]).
It is well not to seize and twist off the anterior extremity, as this might lead to the ripping out of a larger portion than was intended. Besides, it might cause fracture of the base of the remaining piece of the inferior turbinal bone and this might become displaced inwards so as to block the air-way more than ever.