3.2\ Septoplasty

3.2.1\ Discussion

Septoplasty is performed to treat a deviated nasal septum and can be performed in conjunction with rhinoplasty (septorhinoplasty). Classic septoplasty consists of creating a mucoperichondrial flap in order to remove the offending portion of the nasal septum via sharp dissection (Fig. 3.3). Silastic sheets or stents are often inserted along

a

both sides of the nasal septum to prevent the formation of adhesions (Fig. 3.4). These are later removed once the surgical site heals. The postoperative imaging appearance often consists of a straightened and thinned nasal septum with widened nasal passages, which can be subtle. Complications are uncommon and include hemorrhage, cerebrospinal fluid leak, infection, septal hematoma or abscess, overcorrected septum, septal perforation (Fig. 3.5), adhesions, and sensory disturbances.

b

Fig. 3.3  Septoplasty. The patient has a history of a deviated nasal septum with spur causing nasal obstruction. Preoperative axial CT image (a) shows leftward deviation of the nasal septum with a spur. Axial CT image obtained

1 year after surgery (b) shows interval removal of the spur and straightening of the nasal septum. There is also increased opacification of the left maxillary sinus

Fig. 3.4  Nasal stents. The patient has a history of nasal septal deviation and adhesions treated via septoplasty and lysis of adhesions. Coronal CT image shows a straight, midline septum flanked by bilateral nasal stents (arrows)

Fig. 3.5  Septoplasty perforation. Axial CT image shows a defect in the anterior nasal septum. The septum is otherwise straight. However, there is acute sinusitis

Fig. 3.6  Nasal septal button prosthesis. Axial CT image shows the two discs connected to one another across the nasal septal defect (arrow)

3.4\ Inferior Turbinate

Outfracture and Reduction

3.4.1\ Discussion

Inferior turbinate outfracture and reduction are treatment options for nasal obstruction related to inferior turbinate hypertrophy. Outfracture consists­ of laterally displacing the inferior turbinates,­ while radio-frequency treatment

a

b

coagulates the inferior turbinate submucosa. This results in a widened nasal airway passage. The procedures are often performed in conjunction with septoplasty. Lateral displacement of the anterior, middle, and posterior portions is usually apparent on postoperative sinus CT (Fig. 3.7). Alternatively, turbinate reduction surgery typically results in a truncated appearance of the inferior turbinates and enlargement of the nasal passages (Fig. 3.8).

Fig 3.8  Inferior turbinate reduction. Coronal CT image shows truncation of the inferior portions of the bilateral inferior turbinates. Findings related to endoscopic sinus surgery are also apparent