Endoscopic Septoplasty: Revisitation of the Technique, Indications, and Outcomes

Abstract

Septoplasty is a well-described surgical technique for management of nasal airway obstruction (NAO) and improved access for endoscopic sinus surgery (ESS). The advances in endoscopic techniques have facilitated endoscopic septoplasty (ES). The purpose of this study was to review the surgical technique, indications, and outcomes for ES. A retrospective review was conducted to identify patients undergoing ES between 1998 and 2005 at a tertiary care medical center. Demographic data, operative indications, adjunctive procedures, symptom outcome, and complications were recorded. One hundred sixteen patients with a mean age of 47 years were identified. The male/female ratio was 1.2:1 and mean follow-up period was 13 months. Indications for ES included NAO (64.6%), access (34.5%), and facial pain (0.9%). The most common concomitant diagnoses included chronic rhinosinusitis (67.2%), allergic rhinitis (55.2%), sinonasal polyposis (34.5%), and turbinate hypertrophy (25.9%). Concomitant procedures performed included ESS (81.9%), turbinate reduction (44.8%), and rhinoplasty (4.3%). Among patients who underwent primary ES for NAO, 70% achieved resolution and 20% reported improvement of their nasal obstruction. Complications included transient dental pain/hypesthesia (4.3%), asymptomatic septal perforation (3.4%), synechiae formation (2.6%), epistaxis (0.9%), and septal hematoma (0.9%). Complication rates were similar for ES alone versus ES in conjunction with ESS. ES represents a viable alternative to traditional headlight septoplasty with acceptable outcomes and complications. ES allows for enhanced visualization of the septal deviation with more focused flap dissection and resection of the offending cartilage and bone. Furthermore, the technique facilitates teaching endeavors through use of video monitors.