Septoplasty and/or submucous resection?

Abstract

Information obtained from the case-records and completed questionnaires from 478 patients operated in the 5-year-period 1980 through 1984 with either septoplasty or submucous resection (SMR), has been analysed on an average 31 months after surgery. Two hundred (42 per cent) underwent SMR and 278 (58 per cent) septoplasty. Twenty per cent presented for a clinical follow-up examination. Of the 478 patients, 63 per cent were satisfied. More patients were satisfied with the functional results after septoplasty, which also resulted in fewer and smaller perforations than SMR. Septoplasty ought to replace the latter as the routine procedure. 10 per cent had troublesome crusting independent of the technique used. Change in the external shape of the nose is a minor problem for the patients, and was not regarded as an indication for re-operation. Patients with allergic rhinitis may undergo septal surgery on general lines. - IntroductionThe submucous resection operation (SMR), as we understand and perform it today, was first described by Freer (1902) and by Killian (1904). They both, independently, recommended visualization of septal cartilage and bone, while preserving the overlying mucosa. The mucosa was allowed to fall into median apposition after the framework that held it off-centre had been carefully removed. The principle of saving a dorsal cartilaginous strut was established to avoid collapse of the supratip (Freer, 1902), while Killian also preserved a caudal strut (1904).The septoplasty operation was introduced approximately half a century later (Cottle and Loring, 1946;Goldman, 1956;Cottle, 1960), and has been subsequently modified on numerous occasions. The sine qua non of all methods is the conservation and relocation of septal supporting tissues. Septoplasty has to a large extent replaced SMR as the routine technique without solving all the problems of this type of surgery. Several studies in the literature reveal that 25-35 per cent of patients do not achieve a satisfactory result (Sloth and K0lendorf, 1976;Peacock, 1981;Stoksted and Gutierrez, 1983; Dommerby etal., 1985). We have therefore examined retrospectively the results of five years of septum operations at our institution.

‘Valve-stabilised’ rhinospirometry can predict the benefit of septal surgery: a pre- and post-operative correlation study

“…The current selection process for nasal surgery involves purely subjective assessments, both from the patient's opinion and an ENT doctor's clinical assessment of their nasal obstruction, often with no validated scoring system. This lack of objectivity in the operative selection process may be why septal surgery, for many candidates, is an ineffective procedure with high failure and dissatisfaction rates reported at 63-70.5% in some studies [8][9][10]. This high level of patient dissatisfaction may also be because the symptom of nasal obstruction was erroneously linked to the presence of septal deformity without consideration of other factors.…”

“…Therefore, the finding of septal deviation in patients attending with nasal blockage is common, but it may not necessarily be causative of the symptom presentation. This may explain the significantly high level of post-operative patient dissatisfaction following treatment of nasal blockage with septal surgery [8][9][10][11][12], as the obstructing cause may not have been addressed. Another reason for the failure of therapeutic effect following septal surgery is that the degree of deformity could be within the normal airflow symmetry range [13] and the treatment itself not sufficient to improve the symptom of nasal blockage.…”

French otorhinolaryngology society guidelines for day-case nasal surgery

“…Several studies mentioned hemorrhagic complications, affecting 0-7% of cases, and mainly comprising septal hematoma and epistaxis at unpacking dates [12][13][14][15].…”

The accuracy and reproducibility of rhinospirometry in detecting flow asymmetry in a nasal cavity model

“…However, given the high incidence of septal deviation within the natural asymptomatic population [2,3], the influence that airflow asymmetry has on an individual's subjective sensation of nasal airflow obstruction is often over-estimated such that surgical intervention to correct the septal deformity may neither be necessary nor appropriate. The over estimation of symptoms ascribable to nasal airflow asymmetry by both the patient and the examining clinician may be the reason for the high incidence of patient dissatisfaction following surgical treatment of the septum for the symptom of nasal obstruction [4][5][6][7][8][9].…”