Can CT Scans Predict Need for Septoplasty in Sinus Surgery?

Objective: 1) Ascertain whether CT findings correlate with surgical need for access septoplasty during endoscopic sinus surgery. Evaluated due to risk of litigation from patients not consented for septoplasty who require it, despite having a “straight septum” on CT. 2) Establish whether site of septal deviation affects the requirement for septoplasty. Method: We retrospectively studied 129 endoscopic sinus surgery procedures. The preoperative CT report was recorded. Blinded to the report, 2 independent observers commented on evidence and site of septal deviation and predicted the need for access septoplasty. The operative notes were used to record the surgical outcome. Results: Septal deviation was reported by radiologists in 57 of the 129 patients (44%). Both observers agreed on septal deviation being present in 85 patients (66%). Thirteen of 87 patients who were predicted not to need access septoplasty underwent the procedure (15%). A confidence interval (CI) of 95% gives a range of 9%-24% for patients undergoing access septoplasty who were predicted not to. Eight of 72 patients who had no septal deviation reported on CT underwent access septoplasty (11%). A CI of 95% gives a range of 5%-21%. The most common site of septal deviation requiring septoplasty was antero-medial (33%). Conclusion: CT scans cannot always be used to reliably predict the need for access septoplasty. Preoperative clinical examination is the gold standard for assessment. Therefore, patient consent should include that for septoplasty to decrease the chance of litigation should complications of septoplasty occur.