Lack of impact of radiologic septal measurements upon patient symptoms and performance of septoplasty during endoscopic sinus surgery

Abstract

Background: Recent literature suggests that concurrent septoplasty during endoscopic sinus surgery (ESS) improves patient outcomes, however, the underlying indications for performing concurrent septoplasty are unknown. The objective of this study was to investigate the relationship between objective radiologic measures of nasal septal deviation with preoperative patient symptomatology and measures of CRS disease severity. We also sought to understand the association of objective radiologic measurements with surgeon performance of concurrent septoplasty during ESS.Methodology: Seventy-four patients with CRS undergoing ESS were prospectively enrolled. Angles of septal deviation, intranasal areas and volumes were assessed on preoperative computed tomography (CT) scans and correlated with a robust battery of patient reported outcomes measures (PROMs), objective measures of CRS severity including olfaction scores, radiologic and endoscopic staging, and performance of septoplasty.Results: Intranasal areas and volumes demonstrated only weak linear associations with patient-reported nasal congestion, however, angles of septal deviation alone did not correlate with congestion or any other PROM measure. Meanwhile, radiologic septal-related measurements did not correlate with objective measures of CRS disease severity or the performance of a concurrent septoplasty.Conclusions: Though prior studies demonstrate improved patient outcomes in the setting of concurrent septoplasty during ESS, this study failed to establish an association between preoperative radiologic septal-related measurements and patient symptomatology or surgeon decision to perform septoplasty. Although objective factors to identify patients most likely to benefit from concurrent septoplasty remain unidentified, the potential improvement of surgical recommendations and patient outcomes makes this an important area of continued investigation.

Radiological Assessment of High Anterior Septal Deviation and Its Impact on Sinus Access

“…A study by Rowan et al recently examined the association of radiological measurements of septal deviation with the surgical decision to perform concurrent septoplasty during ESS. 3 They examined the angle of deviation at the coronal level of the anterior aspect of the nasal bone, the head of the inferior turbinate, the crista galli, and just anterior to the optic nerve. However, they found no significant association of their measurements to the decision to perform septoplasty.…”

“…A recent study sought to define objective radiological measurements associated with the decision to perform septoplasty; however, they did not identify any associations. 3 The present study focuses on high anterior septal deviation (HASD). It is an anatomic variant that has not been well studied, potentially due to the paucity of associated skull base abnormalities.…”

“…Significant variations, however, in surgical practice patterns remain. A recent study sought to define objective radiological measurements associated with the decision to perform septoplasty; however, they did not identify any associations 3 …”

Prevalence and clinical implications of high anterior septal deviation on sinus access: a retrospective cross-sectional study

“…However, no statistically significant correlation was observed between the measurements taken and the decision to conduct septoplasty. They recognized that this could have been the result of their inability to comprehend the surgeon's justification for conducting septoplasty [12].…”