Informed consent for septal surgery: the evidence-base

Abstract

Informed consent is becoming an increasingly important issue in patient care. Inherent in this is the ability to accurately inform patients of the risks and complications involved in surgery. Nasal septal surgery is commonly performed by otolaryngologists and although often considered routine has a number of recognized complications that can have a significant effect on life quality. We carried out a review of the literature over the last 25 years and reviewed studies quoting rates of complications after septoplasty and submucous resection (SMR) using strictly applied criteria for study inclusion. There was a paucity of prospective data, especially for the cosmetic effects of septal surgery. Rates of septal perforation were two to eight per cent for SMR and 1.6-5.4 per cent for septoplasty. The incidence of cosmetic deformity was low for both procedures zero to one per cent. More well-designed studies are required to augment the current evidence base. While this does not replace the need for surgeons to audit their own results it provides evidence-based information to assist in the process of informed consent.

The diagnosis and management of rhinitis: An updated practice parameter

“…527 Septoplasty, 528 which involves reshaping, repositioning, or recontouring the cartilage, has a high reported success rate 529 and is preferred over submucosal resection, a procedure that involves more extensive resection of cartilage and bone. 529,530 Turbinate hypertrophy reduction surgery may be performed in conjunction with or separate from septoplasty, depending on the surgical assessment. 531,532 The various surgical procedures available (eg, bipolar cautery or radiofrequency ablation) 524,533-535 alleviate the mucosal hypertrophy, the bony hypertrophy (eg, submucosal resection), or a combination of bony and mucosal hypertrophy (eg, powdered turbinoplasty or laser turbinectomy).…”

“…Submucosal resection involves more extensive resection of cartilage and bone, is less tissue-sparing, and has a higher incidence of septal perforation complications. 530 Septoplasty, currently the preferred procedure, reshapes, repositions, or recontours the cartilage, with as many as 77% of patients achieving subjective improvement. 529 The exact techniques, such as scoring, morselization, or removal of cartilage, with manual or powdered instrumentation, 973 and/or the use of cartilage grafts will depend on the type and severity of the septal deviation.…”

A prospective objective study of the cosmetic sequelae of nasal septal surgery

“…Retrospective studies without photographic documentation report a higher rate of cosmetic changes [8,9]. The issue of informed consent for septal surgery has been addressed before [5,7]. Inadequately informed patients are more likely to pursue legal action [10].…”

“…Considering the amount of septoplasties performed, and the potential for significant complications, there is a paucity of prospective data [5]. Only two studies have examined the issue of cosmetic changes prospectively [6,7]; however, both only used semi-quantitative outcome measures.…”

Fehler und Gefahren: Tonsillektomie und andere Standard-Eingriffe

“…Dennoch wurden Septumabszess, Perichondritis, Sepsis, Endokarditis, Meningitis, Hirnabszess, Sinus cavernosus Thrombose [ 396 ] und toxisches Schock-Syndrom berichtet [ 110 , 364 , 396 -398 ] . Für das toxische Schock Syndrom wurde rechtskräftig festgelegt, dass es sich um eine eingriff suntypische und nicht aufklärungs-pfl ichtige Komplikation handelt [ 111 ] .…”