Functional rhinoseptoplasty: clinical decision protocol

Abstract

Introduction: Functional Rhinoseptoplasty (F-RSP) is a complex procedure with increased morbidity and substantially longer operative time compared to conventional septoplasty. On this regard, the clinical decision concerning this procedure should be thoughtful and objective. Both the nasal septum and the internal and external nasal valves play crucial roles in nasal airflow, emphasizing the importance of directed physical examination in patients with chronic nasal obstruction. As a surgical procedure with facial aesthetic impact, the joint definition of appropriate aesthetic goals between physician and patient, the presence of body dysmorphic syndrome and recognition of prior and/or concomitant psychiatric pathology are of paramount importance.
Objectives: To present a diagnostic aid protocol and surgical guidance for patients undergoing FSP-R.
Materials and Methods: Literature review and adaptation of published algorithms.
Results: We identified 4 protocols in the international literature. Based on these, a protocol for approaching patients with chronic nasal obstruction and potential candidates for F-RSP was developed within the ENT consultation. Focused on clinical interview, it aims to investigate the real motivations and expectations of candidates for the procedure and to exclude those with uncontrolled psychiatric pathology, particularly in cases of suspected body dysmorphic syndrome. In the objective examination, it proposes methods for evaluating the internal and external nasal valve, nasal septum, and inferior turbinates, establishing a decisional score. It also allows for the description of the nasal pyramid from an aesthetic point of view; standardized photographic documentation of patients and their facial morphing to plan the surgical procedure.
Conclusions: This protocol systematizes surgical indications for F-RSP in ENT consultations. However, it still requires practical application in consultation and recording of the respective results in the Portuguese population for validation purposes.