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Septoplasty Workup

  • Author: Deborah Watson, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
 
Updated: Feb 27, 2015
 

Imaging Studies

A CT scan usually is obtained for concurrent reasons, such as assessing sinus disease or evaluating head and/or facial trauma. A deviated septum is readily apparent on a CT film (see the image below). While septal deviations are apparent on CT scans, obtaining a CT scan is not necessary in a patient in whom no other pathology is suspected (eg, concomitant sinus disease).

Axial CT scan demonstrating severe septal deviatioAxial CT scan demonstrating severe septal deviation. Note left-sided deflection of caudal septum and right-sided nasal airway obstruction due to bony and cartilaginous posterior deviation.

In addition, a study by Sedaghat et al indicated that CT-scan results do not correlate well with physical exam/anterior rhinoscopic/endoscopic findings in septal deviation. Although the study, which involved 39 patients, determined that such correlation was significant with regard to the bony septum, it was not significant with regard to the cartilaginous septum, maxillary crest, and nasal valve.[2]

Plain films are not indicated in most instances; they do not help because the cartilaginous portion of a deviated septum is not easily visible. Direct examination always is best.

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Other Tests

Many proposed methods of nasal airway analysis exist, including rhinomanometry, acoustic rhinometry, and nasal peak flow. The measurements derived from these methods are not always reproducible and do not consistently correlate with a patient's subjective complaint of nasal obstruction. In general, these types of studies are useful for research in nasal obstruction but provide little clinical value in the decision-making process regarding surgery or medical management.

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Contributor Information and Disclosures
Author

Deborah Watson, MD Professor, Residency Program Director, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California, San Diego, School of Medicine

Deborah Watson, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, Phi Beta Kappa, Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Dean Toriumi, MD Associate Professor, Department of Otolaryngology, University of Illinois Medical Center

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;SymbiaAllergySolutions<br/>Received income in an amount equal to or greater than $250 from: Symbia<br/>Received from Allergy Solutions, Inc for board membership; Received honoraria from RxRevu for chief medical editor; Received salary from Medvoy for founder and president; Received consulting fee from Corvectra for senior medical advisor; Received ownership interest from Cerescan for consulting; Received consulting fee from Essiahealth for advisor; Received consulting fee from Carespan for advisor; Received consulting fee from Covidien for consulting.

Acknowledgements

Gregory Branham, MD Vice-Chair, Director, Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, St Louis University School of Medicine

Gregory Branham, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Physician Executives, and Missouri State Medical Association

Disclosure: Nothing to disclose.

Alexander Rivkin, MD Staff Physician, Department of Otolaryngology-Head and Neck Surgery, University of California at San Diego Medical Center

Disclosure: Nothing to disclose.

References
  1. Vainio-Mattila J. Correlations of nasal symptoms and signs in random sampling study. Acta Otolaryngol Suppl. 1974. 318:1-48. [Medline].

  2. Sedaghat AR, Kieff DA, Bergmark RW, et al. Radiographic evaluation of nasal septal deviation from computed tomography correlates poorly with physical exam findings. Int Forum Allergy Rhinol. 2014 Nov 20. [Medline].

  3. Georgiou I, Farber N, Mendes D, Winkler E. The role of antibiotics in rhinoplasty and septoplasty: a literature review. Rhinology. 2008 Dec. 46(4):267-70. [Medline].

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  6. Sundh C, Sunnergren O. Long-term symptom relief after septoplasty. Eur Arch Otorhinolaryngol. 2014 Nov 29. [Medline].

  7. Reber M, Rahm F, Monnier P. The role of acoustic rhinometry in the pre- and postoperative evaluation of surgery for nasal obstruction. Rhinology. 1998 Dec. 36(4):184-7. [Medline].

  8. Hardcastle PF, White A, Prescott RJ. Clinical and rhinometric assessment of the nasal airway--do they measure the same entity?. Clin Otolaryngol Allied Sci. 1988 Jun. 13(3):185-91. [Medline].

  9. Hwang PH, McLaughlin RB, Lanza DC, Kennedy DW. Endoscopic septoplasty: indications, technique, and results. Otolaryngol Head Neck Surg. 1999 May. 120(5):678-82. [Medline].

  10. Kamami YV. Laser-assisted outpatient septoplasty results on 120 patients. J Clin Laser Med Surg. 1997. 15(3):123-9. [Medline].

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  16. Freer OT. The correction of deflections of the nasal septum with a minimum of traumatism. JAMA. 1902. 16:362-75.

  17. Giles WC, Gross CW, Abram AC, Greene WM, Avner TG. Endoscopic septoplasty. Laryngoscope. 1994 Dec. 104(12):1507-9. [Medline].

  18. Hinderer KH. History of septoplasty. Fundamentals of Anatomy and Surgery of the Nose. Aesculapis Publishing Co; 1971. 1-3.

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  20. Killian G. Die sumucose Fensterresektion der Nasenscheiwand. Arch Laryngologie Rhinologie. 1904. 16:362-94.

  21. Manoukian PD, Wyatt JR, Leopold DA, Bass EB. Recent trends in utilization of procedures in otolaryngology-head and neck surgery. Laryngoscope. 1997 Apr. 107(4):472-7. [Medline].

  22. Metzenbaum M. Replacement of the lower end of the dislocated septal cartilage versus submucous resection of the dislocated end of the septal cartilage. Arch Otolaryngol HNS. 1929. 9:282-311.

  23. Peer LA. An operation to repair lateral displacement of the lower border of the septal cartilage. Arch Otolaryngol HNS. 1937. 25:475-89.

  24. Ridenour BD. The nasal septum. Cummings CW, ed. Otolaryngology-Head and Neck Surgery. Mosby-Year Book; 1999. 921-948.

  25. Sessions RB, Troost T. The nasal septum. Cummings CW, ed. Otolaryngology-Head and Neck Surgery. Singular Publishing; 1993. Vol 2: 786-806.

  26. Yanagisawa E, Joe J. Endoscopic septoplasty. Ear Nose Throat J. 1997 Sep. 76(9):622-3. [Medline].

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Cross-sectional area of the nasal cavity at the middle vault level. The ideal angle the caudal edge of the upper lateral cartilage makes with the septum is 10-15°.
Blood supply to the nasal septum derives contribution from the anterior and posterior ethmoidal arteries, the sphenopalatine artery, the septal branch of the superior labial artery (not labeled), and the greater and ascending palatine arteries (not labeled).
Axial CT scan demonstrating severe septal deviation. Note left-sided deflection of caudal septum and right-sided nasal airway obstruction due to bony and cartilaginous posterior deviation.
Location of the hemitransfixion and Killian incisions.
Elevation of the mucoperichondrial flap with a Cottle elevator.
(A) Transcartilaginous incision near the osseocartilaginous junction. (B) Excision of posteroinferior septal cartilage to achieve a swinging door effect. (C) Inferior strip excision of cartilage.
The external nasal approach provides direct visualization of the anterior and dorsal septum and easy access for septal repair.
One technique of incising the septal cartilage involves removing thin wedges from the convex side of the deviated septum to encourage midline repositioning.
Excess and displaced septal cartilage along a hypertrophied maxillary crest can be excised. A straight osteotome may facilitate removal of the bony portion.
 
 
 
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