Publication:

A study comparing conventional septoplasty with endoscopic septoplasty

Background Endoscopic septoplasty provides direct visualization of septal pathology and may be particularly useful for posterior deviations and as an adjunct to endoscopic sinus surgery. This prospective comparative study evaluated the technical and post-operative outcomes of endoscopic and conventional septoplasty.

Methods Fifty patients with significant symptomatic deviated nasal septum were studied prospectively at the Department of ENT, Head and Neck Surgery, Command Hospital (Eastern Command), Kolkata. Twenty-five patients underwent endoscopic septoplasty and 25 underwent conventional septoplasty. Patient symptoms, intraoperative visualization, operative time, blood loss, flap injury, early postoperative bleeding, nasal toilet, pain, postoperative complications and relief of nasal obstruction were assessed. Comparisons were performed using the Chi-square test, with p<0.05 considered statistically significant.

Results Endoscopic septoplasty provided better visualization of the posterior septum (100% versus 72%; p=0.0312) and superior septum (100% versus 68%; p=0.0188). Mean operative time was 52 versus 48 minutes (p=0.777), and intraoperative blood-loss categories did not differ significantly (p=0.230). No flap tear occurred in 80% of endoscopic cases versus 44% of conventional cases (p=0.009 for absence of tears). Early postoperative pack-change requirement (p=0.439), nasal toilet (p=0.315), pain (p=0.697), synechiae (p=0.427) and relief of nasal obstruction (76% complete versus 68%; p=0.325) were not significantly different. Septal haematoma occurred in one conventional case and in none of the endoscopic cases; no septal abscess or perforation occurred.

Conclusions Endoscopic septoplasty demonstrated technical advantages in visualization and flap preservation, particularly for posterior or limited septal pathology. Overall postoperative symptom relief and complications were broadly comparable between techniques. Conventional septoplasty remains useful for large, caudal and complex deviations.