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/ .X. SB, .X. ("("), .G. U"! // S"")"B $&B. – 2000. – d2. – .
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nasal obstruction // Otolaryngol. Pol. – 1999. – Vol.
53(3). – P. 347- 355.
10. External follow-up of total inferior turbinate
resection for rlief of chronic nasal obstruction / Y.
Freeman, W. Morre, F. Ogren, A. Yonrers //
Laryngoscope. – 1985. – Vol. 95, d9. – P.10951099.
11. Mabry R. Surgery of the inferior turbinates:
How much and when? // Arch. Otolaryngol. Head
Neck Surg. – 1984. – Vol. 92, d5. – P.571-576.
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LASER VASOTOMY OF INFERIOR NASAL TURBINATES AT PAITIONS WITH MEDICINAL RYNYTIS
3. Garyuk, L. Svyrydenko, (. Bobrus
The «Lorydan Clinic»,
61170, Ukraine, Kharkov, Metrostroiteley Str., 24,
tel.: 8(057) 758-23-82;
Department of otorhynolaryngology and child's otorhynolaryngology of Kharkov Medical Academy
of Postgraduate Education,
61170, Ukraine, Kharkov, Korchagihtsev Str., 58,
tel.: 8(057) 711-80-18
The offered method of treatment of medicinal rynytis allows bloodless, in short spaces to decrease the sizes
of, inferior nasal turbinates without the damage of mucous layer, by influence of high-power laser radiation. For
period from 2006 to 2009 year 174 patients with medicinal rynytis were treated by this method. Positive results are
got in the nearest and remote periods, efficiency made 96,8%. A method can be executed both independently and to
complement interferences on partition of nose and additional bosoms.
Key words: medicinal rynytis, inferior nasal turbinates, laser vasotomy.
48
, 1 ’2009