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Main Article

COMPARATIVE STUDY OF ENDOSCOPIC AIDED SEPTOPLASTY

AND TRADITIONAL SEPTOPLASTY IN POSTERIOR
NASAL SEPTAL DEVIATIONS
M. Gupta, G. Motwani*

ABSTRACT: Patients with deviated nasal septum are advised surgery, which has seen several
modifications since its inception. This recent technique of using nasal endoscopes gives better illumination
and access to posterior septal deviations. The aim of the study was to identify the nasal septal pathology
in relation to lateral nasal wall in a precise way and to correct this with minimal exposure, limited
manipulation and least resection. Twenty five patients underwent endoscope aided and 25 conventional
septoplasty. Results were graded on subjective and objective improvement. Endoscopic aided septoplasty
(Otolaryngol Head Neck Surg, 1999; 120, 678; Laryngoscope 1994, 104, 1507; J Laryngol Otol 1998,
112, 934; Ear Nose Throat J 1997, 76, 622) was found to be safe, effective and conservative approach
with better patient compliance, shorter recovery time and greater stability of remaining septum.
Key Words: Endoscope; septal deviation; septoplasty

Surgery on a deviated nasal septum has changed a lot, starting

from radical septal resection to mucosal preservation and
subsequent preservation of the possible septal framework,[1]
as the latter gives rise to lesser complications, allows
concomitant rhinoplasty or a revision surgery later and
moreover conservative surgery can be safely performed in
children.
In traditional nasal septal surgery there is often over exposure,
unnecessary manipulation of the septal anatomy and more
resection. Relatively poor illumination, accessibility and
magnification call for more exposure by a large incision and
by elevation of flaps on both sides of the septum.
In this prospective randomized study carried at tertiary referral
centre patients presenting with symptoms and signs of deviated
nasal septum were selected. The aim was to identify nasal
septal pathology in relation to lateral nasal wall[2] in a precise
way, to correct the pathology and to correlate the efficacy of
endoscopic septoplasty with traditional approach.
Endoscope aided limited resection and thus more conservation
by guiding precise shaving of septal sartilage.

MATERIALS AND METHODS

The 50 cases of deviated nasal septum especially high and
refractory to conservative medical treatment with long term
nasal obstruction and headache were selected from the
outpatient department of otorhinolaryngology.
Patients having upper respiratory tract infection allergic
rhinitis were excluded from the study. Twenty-five cases were
randomly selected for conventional septoplasty assigned group
A, other 25 underwent endoscopic aided septoplasty assigned
group B.
Study was carried from April 2000 to March 2001.
A detailed history regarding presenting complaints, history
of present illness with special note of presence or absence of
symptoms [3,4] like nasal obstruction, nasal discharge,
hyposmia, sneezing, nasal bleeding and postnasal drip was
taken.
The detailed general physical examination and examination
of nose and throat were carried out. Detailed nasal endoscopic
examination[5] under local anaesthesia (4% xylocaine with no

Research Associate, *Senior Specialist, Department of ENT, Safdarjang Hospital, New Delhi, India
Indian Journal of Otolaryngology and Head and Neck Surgery Vol. 57, No. 4, October-December 2005

310

Comparative study of endoscopic aided septoplasty

vasoconstrictors added) using rigid 0 and 30, 4 mm fibreoptic nasal endoscopes was carried out. Presence of deviated
nasal septum, turbinate hypertrophy, polyps, chronic sinusitis
were noted.
Besides routine haematological tests and urine examination,
X-ray of paranasal sinuses Waters view was done. If
associated with chronic sinusitis noncontrast computerized
tomogram especially coronal section at osteomeatal complex
was done.
Preoperatively injection tetanus toxoid 0.5 ml intramuscular
was given, xylocaine sensitivity was done. Injection pethidine
50 mg and injection phenargan 25 mg were given
intramuscular 2 h prior to surgery. Cotton strips soaked in
4% xylocaine with adrenaline (one in 30 000) were packed
in both nasal cavities 10 min prior to surgery.
Technique For Conventional Septoplasty
After infiltration with 2% xylocaine with adrenaline into
columella and septum under headlight incision was made at
caudal[6] border of septal cartilage on concave side.[1] The
mucoperichondrial and periosteal flap was elevated. The
cartilage was freed from ethmoids posterior and maxillary
crest below. The 0.5 cm wide anterior margin of perpendicular
plate of ethmoid was removed with lucs forceps. The inferior
cartilaginous strip of 0.5 cm was removed to achieve
correction if necessary. The incision was closed using 30
chromic catgut suture. Bilateral nasal cavities were packed.
Technique For Endoscopic Septoplasty
Infiltration was given on the convex side on the most deviated
part of septum using 0 4 mm endoscope.[711] A vertical
incision was made caudal to the deviation and yet cephalic
and parallel to the classically described hemitransfixation
incision. Also it was not extending from dorsum to the floor
as in classical incision but extended both superiorly and
inferiorly just as needed to expose the most deviated part.
A submucoperichondrial flap was raised using a suction
elevator under direct visualization with a 0 rigid 4 mm
endoscope. The flap elevated was limited as it was raised from
over the most deviated portion of the nasal septum, i.e.
posteriorly, without disturbing the anterior normal septum.
Septal cartilage was incised parallel but posterior to the flap
incision and caudal to the deviation. If the deviation was found
to be mainly bony the incision was made at the bonycartilaginous junction. An elevator was then inserted and the
mucoperichondrial/periosteal flap was raised on the opposite
side. The small lucs was used to excise the deviated portion.
The flap was repositioned back after suction clearance and
edges of the incision were just made to lie closely without the
need to suture. The nasal cavity was packed with merocele

that is sponge like, expands on getting wet and provides

uniform pressure over all surfaces in contact. It also contours
the nasal cavity to exert a tamponade effect thus preventing
septal hematoma formation. It also avoids mucosal abrasions
while doing packing and removal.
Postoperative Care
Patients were given oral antibiotics, analgesics and
antihistamines. They were discharged following pack removal
after 48 h.
All patients were followed[12] up as outpatients 7, 15, 30 and
90 days after the surgery and were assessed for subjective
improvement,[2] e.g. headache, nasal obstruction, rhinorrhoea,
postnasal drip and hyposmia. Objective assessment was done
by nasal endoscopic examination.
RESULTS
The nasal intraoperative findings revealed high deviation to
be bony in majority, 48% (12/25) cases had bone deviation in
both groups as depicted in [Table 1].
Most of the patients were discharged within 48 h of surgery
i.e. following pack removal, five patients of conventional
septoplasty required a longer stay due to bleeding[13] or lip
oedema as shown in [Table 2].
Symptomatic improvement was mainly observed in nasal
obstruction and nasal discharge. The findings are documented
in [Table 3].
Table 1: Deviated portion seen intraoperatively
Deviation

Group A

Group B

(a) Cartilage

7 (28%)

8 (32%)

(b) Bone

12 (48%)

12 (48%)

(c) Both

6 (24%)

5 (20%)

Table 2: Postoperative stay

Duration

Group A

Group B

<48 h

20 (80%)

24 (96%)

4872 h

2 (8%)

1 (4%)

>72 h

3 (12%)

0 (0%)

Table 3: Postoperative symptoms relieved

Symptoms relieved

Group A

Group B

Nasal obstruction

21 (84%)

24 (96%)

Nasal discharge

19 (76%)

22 (88%)

Headache

23 (92%)

25 (100%)

Indian Journal of Otolaryngology and Head and Neck Surgery Vol. 57, No. 4, October-December 2005

Comparative study of endoscopic aided septoplasty

On scale of subjective improvement 80% patients of group A

reported very good improvement while 96% in group B
reported so. Details in [Table 4].
The objective improvement as judged by endoscopy
postoperatively revealed 1 (4%) and 2 (8%) patients of group
A had residual/recurrent deviation and synechiae respectively,
while no such finding was noted in any of group B patient.
CONCLUSION
This study of comparison between traditional septoplasty and
endoscopic aided septoplasty in posterior nasal septal
deviations was carried over 50 patients and they were followed
up for a minimum period of 3 months postoperatively. The
results were assessed in terms of symptomatic improvement
(subjective), endoscopic findings (objective) and
complications, if any.
In our study, in both groups the high deviation was found to
be bony in majority, indicating high prevalence of bony
pathology in nasal septal deviation.

obstruction = 0.15, P value for nasal discharge = 0.27).

In the study by Nayak et al[9] endoscope aided septoplasty
was found to be more effective in treating symptoms such as
nasal obstruction and headache. In this P value was significant,
i.e. <0.02 and <0.05, respectively.
In our study and similarly in the study by Nayak et al the
complication rates were significantly more in the traditional
group.
Overall the study showed better results and less complications
in endoscopic septoplasty as compared to traditional
septoplasty group as endoscope gives better illumination and
improved access to high deviated nasal septum and allows
limited incision, limited flap elevation and achieves correction
with least resection. This technique causes less trauma to the
septum, thus reducing the postoperative complications.
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In the traditional septoplasty group five patients required a

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oedema while in endoscopic group only one patient had to
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Table 4: Postoperative subjective improvement

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Group B

Very good

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2 (8%)

1 (4%)

Satisfactory

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0 (0%)

No change

2 (8%)

0 (0%)

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Address for Correspondance

Dr. M. Gupta
24/702 East End Apartments,
Mayur Vihar Phase I Extension, New Delhi 110096, India
E-mail: mg24702@yahoo.co.in

Indian Journal of Otolaryngology and Head and Neck Surgery Vol. 57, No. 4, October-December 2005