Turbinate Scissors and Heymann Forceps: Nasal Reduction

Ask five rhinologists what they reach for during an inferior turbinate reduction and you will get five answers. Some work almost entirely with a microdebrider. Some still do a clean submucous resection with cold steel and get better long-term mucociliary function for it. What almost all of them agree on is that the cutting instrument has to be angled, blunt-tipped, and long enough to reach the posterior end of the turbinate through a nostril that is roughly 15 mm wide at the vestibule.

That is the design brief the Heymann pattern was built to answer.

What the Heymann pattern solves

The inferior turbinate sits low and lateral on the nasal side wall. Its posterior end, the part most often responsible for obstruction, lies 60 to 70 mm from the nostril rim in an adult. A straight scissor cannot get there without the surgeon’s hand blocking the endoscope or the headlight beam. Angling the shanks moves the hand out of the optical axis while keeping the blades parallel to the turbinate surface.

Heymann turbinate scissors carry that angulation on the side, so the blades stay flat against the lateral wall as the shanks rise away from the field. The blades themselves are short relative to the shank length, typically 25 to 30 mm of working edge on a 178 mm instrument, which gives controlled bites rather than long uncontrolled cuts near the sphenopalatine artery branches.

Two details separate a good pair from a mediocre one:

Blunt, rounded tips. Sharp points in the nasal cavity puncture mucosa you meant to preserve. On a submucous resection the whole point is to keep the mucoperiosteal envelope intact and take bone from underneath it. Rounded tips let you spread bluntly before you cut.

Non-ratcheted finger rings with a strong return spring. There is no ratchet on this instrument and there should not be. The surgeon is opening and closing continuously in a wet field, often one-handed while holding a 0-degree endoscope in the other.

Angled on side versus angled on flat

Catalogue listings blur these two and buyers regularly receive the wrong geometry. Angled on side means the bend is in the plane of the blades, so looking down at the instrument from above you see the shanks deviate left or right. Angled on flat means the bend is perpendicular, so the blades sit below the shank line. For turbinate work you almost always want angled on side. Angled on flat is more useful for septal and choanal work where you are cutting downward.

When you order, specify the plane in writing. “Angled 7 inch” is not a specification.

Specifications you should hold a supplier to

The satin finish point gets ignored and it should not. A mirror-polished scissor under a xenon headlight in a nasal cavity produces a bright specular flare exactly where you are trying to see.

The rest of the nasal reduction tray

Heymann nasal forceps

Confusingly, the same eponym attaches to a through-cutting nasal forceps with cupped, side-biting jaws. These are used to nibble the anterior end of the turbinate and to trim redundant mucosa after the bone has been taken. Standard jaw widths are 3 mm and 4 mm, on 12 to 13 cm shafts. The through-cutting action matters: a crushing forceps leaves devitalised mucosal tags that slough and crust for weeks afterwards.

Check the jaws by closing them on a strip of paper. A true through-cutting jaw cuts a clean disc. A worn one folds the paper.

Elevators

A Freer or Cottle elevator raises the mucoperiosteal flap off the turbinate bone before any bone is removed. The Freer is double-ended, one sharp and one blunt blade, 4 mm wide, 190 mm long. Start the plane at the turbinate head with the sharp end, then switch to blunt and work posteriorly. If you find yourself pushing hard you are in the wrong plane. The same elevator family shows up in septal work, which is why it appears in both the turbinate tray and the septoplasty instrument set.

Exposure and the outfracture step

A Killian or Vienna speculum with 50 to 75 mm blades holds the vestibule open for the cold-steel approach; longer Killian blades reach further but block the endoscope, so endoscopic surgeons often use a shorter blade or none at all. Instrument selection here is covered in more detail in our nasal speculum comparison.

The outfracture itself is done with a blunt elevator or a dedicated turbinate outfracture instrument, not with the scissors. Lateralising the turbinate is a separate manoeuvre from resecting it, and combining the two on one instrument is how mucosa gets torn.

Cold steel or powered?

Microdebrider-assisted turbinoplasty running a 2.9 to 3.5 mm blade is faster and reduces intraoperative bleeding. But six-year follow-up data on submucous resection shows the highest sustained nasal patency and the best restoration of mucociliary clearance and IgA secretion, and cold instruments cost a fraction of a powered console with disposable blades.

For a district hospital in a market where a microdebrider blade costs more per case than the entire instrument set amortised, the cold-steel tray is not a compromise. It is the correct clinical and economic answer. The turbinate scissors, a Freer, a through-cutting forceps and a bipolar are enough to do the operation properly.

Care between cases

Nasal instruments come off the field loaded with blood and mucus, and both dry fast in the narrow blade gap. Three habits protect the edge:

Immerse in an enzymatic solution within 15 minutes of use rather than letting the instrument sit on a dirty trolley. Ultrasonic clean in the open position so cavitation reaches the joint. Lubricate the screw joint with a water-soluble instrument milk before every autoclave cycle, not occasionally.

Scissors used on turbinate bone edges will dull faster than soft-tissue scissors. Budget on resharpening turbinate scissors roughly every 80 to 120 cases; a Supercut blade needs factory regrinding rather than a routine hone, because the razor edge is applied to only one blade.

Fizza Surgical manufactures ENT and nasal instruments in Sialkot under ISO 13485, with CE marking under EU MDR. Our full range is listed under surgical instruments, and quality documentation is available on the certifications page.