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T&A done for sleep apnea for 3 year old, outfractured inferior turbinates, but mouth breathing, nosebleeds persist.Turbinate outfracturing effect ?

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turbinate outfracturing only 3 year old :

My 3 year old had a T and A done about four months ago for sleep apnea. He also has pollen allergies with pretty bad nasal congestion as his main symptom. During the T and A, the ped ENT outfractured his inferior turbinates , as he said he does this routinely in children with predominant nasal obstruction symptoms even if turbinates are normal in size during the procedure. He told me there were absolutely no risks or complications to this procedure, that it could only help him with his allergies. Now, four months later, he still mouth breathes and gets nosebleeds from time to time in his left nostril. Also, He has a lot of nasal crusting in both of his nostrils. Can this be from minor outfracturing or would it be more likely to be from allergies? We do nasal irrigation at night, but there is still a lot of nasal crusting in the am. We live in a fairly humid environment with no heater running. I asked our ped ENT and was told that it was all related to a habit of mouth breathing drying out his nasal airways, but in reading stuff online I am worried that the turbinate outfracture was unnecessary and may be the culprit and wanted another opinion. Thanks.
Posted Tue, 24 Apr 2012 in Ear, Nose and Throat Problems
Answered by Dr. Naveen Kumar 52 minutes later

Thanks for the query

Turbinoplasty - Also known as reduction of turbinates is usually performed in those conditions wherein the turbinates are enlarged enough to cause narrowing of the nostrils and difficulty in breathing.

Turbinoplasty is generally performed in adults and seldom in children (Int J Pediatr Otorhinolaryngol. 2007 Jun;71(6):921-7. Epub 2007 Apr 5.), suffering from either allergic rhinitis or vasomotor rhinitis. It is usually avoided in children as it can lead to atrophic rhinitis (repeated drying of the nasal mucosa with crusting).

Ideally, once the Adeno-tonsillectomy is performed, most of the children get relieved from the nasal obstruction, but a few of them do continue with mouth breathing as they would have become habitual to the previous situation and will not make an active effort to breathe through the nose. Following turbinoplasty, until the mucosa heals completely there will be some amount of bleeding as well as nasal crusting. Because of the crusting the child continues to have nasal block and reverts back to mouth breathing.

In your situation the doctor should have performed the turbinoplasty in a second sitting after assessing the nasal block rather than combining with Adeno-tonsillectomy. Following Adeno-tonsillectomy there will be enough space created for the child to breathe, if turbinoplasty is also done in the same sitting then there will be drying of the mucosa because of excessive flow of air.

Now, the surgery has already been performed, the best thing to do is, using saline nasal spray 3-4 times a day to clear the crusts and keep the nasal mucosa moist. Also, encourage the child to drink plenty of water to keep hydrated and use steroid nasal spray during allergic episodes.

Hope I have answered your query;

Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by
Follow-up: T&A done for sleep apnea for 3 year old, outfractured inferior turbinates, but mouth breathing, nosebleeds persist.Turbinate outfracturing effect ? 5 days later
Would there likely be continued problems with crusting and nasal dryness from simple outfracturing rather than a partial turbinectomy. None of his turbinate was removed, it was just pushed slightly lateral. I can still see both turbinates when I look in his nose. I just thought maybe the nasal crusting could be from allergies.

I did read some of those articles in that journal and it talked more about volume reduction of the turbinates. I thought with outfracturing volume was not lost and they functioned the same. So with all this said, can nasal crusting be simply from allergies or can a simple lateral outfracture cause crusting and atrophic rhinitis without resection of the turbinate. Thanks again.
Answered by Dr. Naveen Kumar 14 hours later
Hi Dear,

Many a times, fracturing of the turbinates also includes resection of the nasal mucosa. If there was only fracturing of the turbinates done without resection of mucosa over the nasal turbinates, then it is less likely that crusting will occur, as the mucosa over the turbinates is intact. But then there are various other causes which can also cause dryness of the nasal mucosa:

1. Allergic rhinitis leading to excessive loss of water from the nasal mucosa leaving it dry and susceptible for crusting.

2. After relieving the previous obstructions, there will be excessive inflow of air into the nasal cavities leading to crusting and following crusting there is nasal block and the child starts breathing through the mouth further worsening the nasal crusting.

To sum it up, just a mere fracturing of the nasal turbinates cannot cause crusting and lead to atrophic rhinitis. Either of the above two causes could be the prime reason for the crusting.

Regular nasal douching with saline nasal spray can reduce the nasal crusting and dryness of the nose. Also, encourage the child to consume plenty of water.

Wishing him good health

Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by
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