How to Approach Nasal Septal Deviations

Gordon H. Sun, MD, MS

December 21, 2015

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.

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