Surgical Management of Nasal Obstruction and Epistaxis

Assessment of Medical Necessity

• The American Academy of Otolaryngology recommends septoplasty as the appropriate procedure for septal deviation causing nasal obstruction, rather than rhinoplasty, for patients with caudal septal deviation and nasal obstruction symptoms 1
• Patients with nasal obstruction and epistaxis due to septal deviation require documentation of moderate to severe vestibular obstruction, and evidence of a 4-week trial of nasal steroids or immunotherapy, as recommended by the American Academy of Otolaryngology 1, 2

Appropriate Surgical Approach for Caudal Septal Deviation

• Septoplasty with bony batten grafting is the recommended surgical intervention for caudal septal deviation, as it provides structural support to the caudal septum and improves the nasal airway, according to the American Academy of Otolaryngology 1, 3

Required Medical Management Before Surgery

• The American Academy of Otolaryngology recommends at least 4 weeks of medical therapy with intranasal corticosteroids before surgical intervention for nasal obstruction and epistaxis due to septal deviation 1, 2
• Comprehensive medical management attempts should be documented, including saline irrigations for nasal hygiene and treatment of any underlying allergic component, as recommended by the American Academy of Otolaryngology 1, 2

Common Pitfalls to Avoid

• Approximately 80% of the general population have off-center septums, but only about 26% have clinically significant deviation causing symptoms, highlighting the importance of proper diagnosis and treatment, according to the American Academy of Otolaryngology 1, 4
• Proceeding with more extensive surgery (rhinoplasty) without first attempting the appropriate procedure (septoplasty) may expose the patient to unnecessary risks, as recommended by the American Academy of Otolaryngology 1, 2