[The effects on nasal mucociliary clearance system of excising partial inferior turbinectomy with HUMMER or microwave].

OBJECTIVE

To study the effects of excising partial inferior turbinectomy with powered sinus clissector (HUMMER) and microwave on nasal mucociliary clearance system, and offer the theoretical foundation to choose rational operational technique.

METHOD

The patients of HUMMER group were excised partial inferior turbinectomies with HUMMER and the microwave group with microwave, each group included 20 patients. Ten patients without nasal disease were selected as control. Every case was drawn nasal mucus of inferior turbinectomy preoperatively, three months and six months after surgery. Five control cases selected randomly were drawn specimens. The specimens were observed under light microscope and scanning electron microscope. Every case accepted saccharin test before the specimen was drawn. All data were analyzed with paired sample t-test and analysis of variance.

RESULT

(1) Saccharin test: MTR(mucociliary transport rate)for before surgery, three months after surgery and six months after surgery with HUMMER were (3.63+/-0.57) ,(3. 76+/-0.43) and (6. 09+/-1. 19)mm/min, respectively. MTR for six months after surgery significantly increased compared with that before surgery and three months after surgery(both P <0. 01). MTR for three months after surgery and six months after surgery with microwave were (3. 96+/-0. 40)and (3. 95+/-0. 32)mm/min,respectively. MTR for three months and six months after surgery both significantly increased compared with that of controls (both P <0. 01). MTR for six months after surgery with microwave significantly increased compared with that with HUMMER ( P <0. 01). (2) Observation of Light microscope and scanning electron microscope: Before surgery with HUMMER and with microwave, goblet cells increased in nasal mucous epithelial of patients. The cilia changes included fracture, disorder, deletion and confluence. Thickness and size of cilia were not coincident. Partial nasal mucous epithelial metaplasis from pseudostratified ciliated columnar epithelium to simple cuboidal epithelium. Nasal mucous epithelia regenerated to pseudostratified ciliated columnar epithelium after surgery with HUMMER, which mainly coincided with normal nasal mucociliary system. Nasal mucociliary epithelial regenerated little after surgery with microwave. There were squamous epithelial metaplasia on nasal mucus and serious deletion of cilia.

CONCLUSION

The surgery of excising partial inferior turbinectomy with HUMMER has obvious advantage in protecting and recovering physiological function of nasal cavity.