Management of Traumatic Nasal Septal Deviation

Introduction to Nasal Septal Deviation

Approximately 80% of the general population has an off-center nasal septum, but only 26% have clinically significant deviation causing symptoms 2, 3
Trauma is the most common etiology of deviated septum, and the degree of trauma required for clinically significant deviation is inversely related to the patient's age—meaning adolescents are at higher risk for developing a functionally significant deviation 2, 3
Anterior septal deviations are much more clinically significant than posterior deviations because they affect the internal nasal valve, which creates more than 2/3 of nasal airflow resistance 2, 3

Before any surgical referral is appropriate, patients must complete at least 4 weeks of medical management, including intranasal corticosteroid sprays, regular saline nasal irrigations, and consideration of mechanical nasal dilators 1
The American College of Physicians recommends documenting the duration of treatment and evidence of persistent symptoms despite compliance 1
Septoplasty should only be considered medically necessary when there is septal deviation causing continuous nasal airway obstruction that has not responded to appropriate medical therapy 1

The obstruction becomes more pronounced over time with cartilaginous overgrowth on the dominant side of deviation 2, 3
Septoplasty is the preferred surgical procedure, with as many as 77% of patients achieving subjective improvement 2, 3

Objective documentation that the septal deviation correlates with the patient's symptoms is necessary before proceeding with surgery 1
A complete trial of medical management is required before considering surgical intervention 1
Many patients with deviated septa are completely asymptomatic and require no intervention 2, 3