Prevalence and clinical implications of high anterior septal deviation on sinus access: a retrospective cross-sectional study

High anterior septal deviation is an underreported anatomical variant that can influence the decision to conduct septoplasty throughout FESS and to facilitate after-surgery care.

To assess the prevalence and clinical implications of HASD on sinus access.

This retrospective, cross-sectional research was performed on patients with symptoms of DNS and CRS who were prepared for FESS. CT scan PNS coronal sections have been requested with three measurements: distance to the septum (SDD), distance to lateral nasal wall (LNW), and septal deviation angle (SDA).

One-hundred fifty-seven patients were included; 73 of them received septoplasty. There is significant increase in SDD (mm), LNW (mm), SDD/LNW, and SDA (degree) in septoplasty group with significant AUC that predict the need of septoplasty. Characteristic cutoffs were SDD more than or equal 2.55 mm, SDD/LNW more than or equal 0.239, and SDA more than or equal 8.95°. There is significant decrease in polyps and edema in septoplasty group postoperatively compared to preoperative.

Septoplasty during FESS allows room for endoscopic instrumentation, provides adequate visualization of the surgical field and throughout postoperative care, and can reduce the possibility of failed FESS.