Diagnosis and management of septal deviation and nasal valve collapse - a survey of Canadian otolaryngologists

Common Causes of Failed Septoplasty: A Systematic Review

Failed septal correction is an undesirable outcome of primary septoplasty. In this systematic review, we aimed to assess all current studies concerning septoplasty failure, with a view to identifying its common causes. A systematic literature search was conducted by screening the PubMed, MEDLINE, Embase, and Cochrane Library databases for studies that assessed septoplasty failure and were published between January 2008 and January 2021. Three authors independently extracted information from each study and examined all included articles for bias. Four articles provided pertinent data regarding septoplasty failure. We gathered that missed nasal valve abnormality diagnosis, insufficient separation and resection of the bony-cartilaginous junction, and insufficient correction of caudal septal deviation could cause septoplasty failure. Additionally, iatrogenic problems, nasal asymmetry, and side-wall concavity involving the nasofrontal and columellar labial angles are contributing factors. Determining the cause of nasal blockage is challenging because it is subjective. Based on our findings, we concluded that in all patients with septal deviation, utmost care should be taken to avoid overlooking nasal valve abnormalities and other nasal diseases before conducting septoplasty. Moreover, inadequate correction of caudal septal deviation should be avoided. Furthermore, there is currently no widely accepted classification system for septal abnormalities to measure and describe septal deviation characteristics, making surgical planning and documentation difficult. Hence, further research that would lead to the creation of such a classification system is warranted.

Nasal Septal Deviation: A Comprehensive Narrative Review

The nasal septum is an osteocartilaginous wall that divides the nose into two nasal cavities. Asymptomatic minor deviation of the septum is considered a normal developmental variation found in the majority of the population. The reported global prevalence rates had great variation due to the extent of deviation considered in the reporting studies. Previous classification systems have been proposed to classify the nasal septal deviation according to the characteristics of the nasal septum seen horizontally and vertically. For some patients, the degree of the deviation may affect the nasal airflow causing obstruction or impairing the olfactory function. Headache, rhinosinusitis, high blood pressure, obstructive sleep apnea, and breathing sounds are also among the clinical presentations of nasal septal deviation. Clinical assessment is sufficient to make the diagnosis while imaging techniques are required for decision-making. Radiological imaging techniques such as computed tomography (CT) are used to classify and assess the severity of the deviated septum. Surgical correction is the treatment option for nasal septal deviation. Septoplasty is the most common procedure used for nasal correction with high satisfaction levels and low complication rates. In this review, we present a comprehensive summary of the concept, presentation, diagnosis, management options, and quality of life of patients with nasal septal deviation.

The Relationship Between Lateral Nasal Wall Collapse and Nasal Obstruction

OBJECTIVES

In clinical practice, lateral nasal wall collapse during forced inspiration is widely regarded as a sign of nasal obstruction or criterion indicating nasal valve surgery. This study aims to evaluate the relationship between the degree of lateral nasal wall collapse and subjective nasal obstruction. In addition, factors related to lateral nasal wall collapse were also investigated.

METHODS

In this study, lateral nasal wall collapse is determined by the degree of lateral nasal wall triangle (LNWT) area reduction on frontal view during forced inspiration compared to quiet inspiration. LNWT area ratio of the patient and control groups was compared. The relationship between the lateral nasal wall collapse and clinical factors including symptom scores, nasal valve angles, skin thickness were evaluated.

RESULTS

The average LNWT area ratio of the patient (n = 24) and control groups (n = 27) was 0.96 and 0.83 respectively (P = .001). Symptom score (NOSE and VAS) is not related to the degree of lateral nasal wall collapse. Moreover, nasal valve angle and skin thickness were also not related to the degree of lateral nasal wall collapse. In 14 of the 19 patients, the more obstructed side corresponded to the side of narrower nasal valve angle, and 5 were not.

CONCLUSION

Lateral nasal wall collapse is not related to a patients' nasal obstruction.