How to Approach Nasal Septal Deviations

Indications for Surgery

The AAO-HNSF clinical consensus statement panel on septoplasty agreed that septoplasty can be an effective adjunctive treatment for several conditions in addition to nasal septal deviation.^[3] The panel concurred that septal deviation is a risk factor for the development of epistaxis, owing to traumatization of nasal mucosa from turbulent airflow at the site of septal deviation. Septoplasty has been reported as a treatment for severe recurrent epistaxis in a patient with Glanzmann's thrombasthenia; it was hypothesized that fibrosis in the septal mucosa following septoplasty contributed to a reduction in vascularity of the nasal septum.^[27]

Septoplasty can play an important role in the management of chronic rhinosinusitis. Facilitation of access for instrumentation during endoscopic sinus surgery is considered an indication for septoplasty.^[3] Septoplasty can also improve intranasal anatomy by relieving any septum-related obstruction of the middle meatus, subsequently improving drainage of the ostiomeatal complex.^[3] Moreover, surgically addressing a septal deviation can improve delivery of intranasal medications.^[28]

Although septoplasty alone generally is not considered sufficient as a treatment for obstructive sleep apnea, it can be used in conjunction with other treatments to enhance positive outcomes.^[29,30,31] Septoplasty with or without inferior turbinoplasty has been shown to improve continuous positive airway pressure tolerance and compliance in patients with obstructive sleep apnea.^[32,33,34]

The AAO-HNSF septoplasty panel agreed that the effect of septoplasty on olfaction is unpredictable.^[3] In a 2004 prospective study using the "Sniffin' Sticks" olfactory test battery, one patient demonstrated improvement in olfaction and five demonstrated a decline 4 months after septoplasty; at 9 months postsurgery, one patient continued to exhibit hyposmia.^[35] A 2008 prospective investigation using the same test battery as the 2004 study found that 13% of patients who underwent septoplasty experienced improvement in olfaction 4 months after surgery, whereas in 7%, olfaction declined.^[36] Patients should be counseled that anosmia or hyposmia is not an indication for septoplasty, and that the impact of septoplasty on olfaction is variable.

Editor's Recommendations Septoplasty New Guidelines for Allergic Rhinitis Released Epistaxis

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Cite this: How to Approach Nasal Septal Deviations - Medscape - Dec 21, 2015.

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