Most people are not familiar with the term “turbinates” unless if these complex, critically important structures are removed from the nose. These structures, the primary ones which are similar in size to our fingers, are sometimes removed or reduced in size in the nose to help open up the airway. Turbinates can become swollen and block the nasal airway because of allergies, non-allergic rhinitis, overuse of intranasal decongestants, or it may be caused by a septal deviation. So doctors trim them down and for good reason.
Remove too much of the turbinates, though, and your life will become a mess. It is sort of like removing your fingers – but far worse. Your breathing and nose become significantly affected. Just like your hand won’t be fully functional if you remove your fingers, neither will your nose if you remove the turbinates. These structures are not visible to the eye because of their location in the nasal cavity, so you can’t tell if someone’s turbinates are present and fully functional or if they have been removed – until you look at the CT scan. Because these structures are “hidden,” in a sense, removal is not as obvious of a problem as people who have their fingers removed. The end consequence of turbinate removal is there is nothing left to remove from the nose! It is already gone!
The turbinates consist of bone sandwiched between mucous layers, and they are rich in blood vessels and nerve endings. The outer portion is thick with significant mucus-producing capabilities. The turbinates serve many important functions for the 18,000 liters of air we breathe and 1-2 liters of mucus that goes through our nose and sinuses each day, including:
1) Directing airflow. The nose directs airflow in an orderly pattern so that air is experienced throughout all regions of the nose.
2) Providing nasal airflow resistance. The nose provides greater than 50% of resistance in overall airflow to our lungs, ensuring optimal lung functioning.
3) Containing nerve cells. Laminar airflow strikes the nasal mucosa, which is embedded with trigeminal receptors (nerve receptors that detect airflow motion and temperature) and these nerve cells tell the brain you are breathing.
4) Humidifying the air we breathe. The turbinates help moisten the air we inspire so it is near 100% humidity by the time it reaches our lungs.
5) Warming the air we breathe. Turbinates help warm air not only by providing nasal airflow resistance, but also the larger and lower turbinate (the inferior turbinate, which is rich in blood vessels) has significant expanding (to decrease cold air intake) and contracting (to allow more air to enter our nose) capabilities. Specifically, the anterior portion of the inferior and middle turbinates plays a significant role in directing and warming air upon inspiration.
6) Filtering the air we breathe. The turbinates provide much surface area to allow infectious particles to strike them, entrapping them in mucus, which is swept into the pharynx where it is harmlessly swallowed.
7) Smelling the air we breathe. The turbinates project a small amount of air, 10% or less, toward the superior turbinates where olfactory bulbs are present that help detect smell.
8) Swelling. The turbinates swell on one side of the nose while the other side constricts ever 2-4 hours, a process known as the nasal cycle.Directing airflow. The nose directs airflow in an orderly pattern so that air is experienced throughout all regions of the nose.
Clearly, the primary turbinates are incredibly complex, serve many important functions, and should be treated with utmost respect. It is important before undergoing any nasal or sinus surgery to have an honest, open discussion with your doctor about how the surgery will affect the mucosa of the turbinates. Before it is too late.
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