Minimally invasive endoscopic septoplasty

Abstract

This paper analyzes a retrospective study of 131 consecutive cases septoplasties performed using our endoscopic procedure. Clarification and new definitions of endoscopic septoplasty approaches are emphasized: Trans-Nasal Endoscopic Septoplasty (TNES) with an endoscope into the nasal fossa and Trans-Septal Endoscopic septoplasty (TSES) with an endoscope into the septal pocket. The patient’s cohort is selected for treatment of persistent nasal obstruction and septal deviation needing surgery. The procedure is carried out on a well-defined homogenous population. Additional actions on inferior turbinate, rhinopharynx, or external procedures for columellar deformities are performed to obtain a free symetric nasal pathway. Most of our surgeries (98%) is carried out endoscopically alone and only 2% of cases necessitated “hybrid” non-endoscopic adjuvant surgery to treat septo-columellar and other major caudal septal deformities as valve surgery. In the studied population, we observed 89% of significant posterior deformities, not only septal. Subjective evaluation of the nasal obstruction is achieved by using a simplified NOSE Scaling (sNOSE) giving an 87.8% satisfaction rate. Results showed a low level of complications such as perforation, hematoma or synechia, confirming the minimally invasive denomination of this procedure (MIES) with minimal operation time, in particular with TNES. Endoscopic Septoplasty (ES) had major advantages in Classical Headlight Septoplasty (HLS), such as enhancing the visualization of posterior nasal region and better final visual evaluation of the global nasal permeability. We recommend Minimal Invasive Endoscopic Septoplasty (MIES) to improve results, minimize complications, and to improve the pedagogic impact of the procedure. Video material illustrates the endoscopic procedures; moreover, ongoing developments in ultra-high, 4K, 4KHDR definition further emphasizes these advantages.