The Effect of Deviated Nasal Septum on Sphenoid Sinus Exposure on Endoscopic Endonasal Transsphenoid Approach

Year 2025, Volume: 8 Issue: 2, 63 - 67, 31.08.2025

Mohamed Sabaa Hazem Dewidar Khaled Azooz Raed Abdellatife , Wael Mohamed Basim Wahba

https://doi.org/10.65396/ejra.1713735

Abstract

• Purpose: Endoscopic Endonasal Trans-Sphenoid Approach (EETA) to sphenoid sinus remains a valuable procedure for both neurosurgeon and ENT surgeon. Structural variants in the form of deviated septum, and concha bullosa were commonly found. This study was to evaluate the effect of deviated nasal septum on sphenoid sinus exposure and the correlation between the site and angle of deviation of nasal septum, the nasal width with the success of approaching the sphenoid sinus ostium.
• Methods: The study included 30 patients with sphenoid or para-sphenoid lesions and septal deviation. All patients underwent an Endoscopic Endonasal Trans-Sphenoid Approach. Preoperative CT was used to calculate the angle of septum deviation and nasal width.
• Results: The mean deviation angle of the participants was 13.77±5.16 and the mean width of the participants was 1.44±0.30. Intervention was done in one third of cases. A significant difference was found between the intervention and non-intervention groups, with a higher median deviation angle in the intervention group (20 degrees). No significant difference was found between the two groups regarding nasal cavity width. Our results shows that the deviation angle is a better predictor than width of the nasal cavity. Regarding deviation angle the cutoff angle at 11.5 is a good discriminating with p value <0.001.
• Conclusion: Septal deviations with an angle greater than 20 degrees significantly affect the visibility of the operative bed, necessitating surgical intervention to improve visibility. Our study concludes that the deviation angle is a better predictor of surgical outcomes than the width of the nasal cavity

Keywords

Endoscopic; Transsphenoid; septoplasty; nasal; width; deviation; angle.

Project Number

N/A

References

• 1. Ismail M, Abdelaziz AA, Darwish M. A comparison between collaborative and single surgeon approach in endoscopic endonasal surgery to sphenoid sinus. Eur Arch Otorhinolaryngol. 2019;276(4):1095-1100.
• 2. Erik C, Huizhong C, Carrau R, Kassam A, Prevedello D. Endoscopic endonasal skull base surgery: Part 1 – The midline skull base. Otolaryngol Clin North Am. 2010;43(3):691-720.
• 3. Kim DH, Hong YK, Jeun SS, Park JS, Kim SW, Cho JH, Park YJ, Kim SI, Kim SW. Is septoplasty necessary when using the Endoscopic Endonasal Transsphenoidal Approach for a deviated nasal septum. Neurol Surg B Skull Base. 2018;79(6):569-573.
• 4. Mitsuhiro T, Yasunori F, Taisuke K, Masahiro K, Stamm AC, Eduardo V, Pedro M, Yu K, Keiji S. Modified combined transseptal/transnasal binostril approach for pituitary lesions in patients with a narrow nasal space: Technical note. Neurol Med Chir (Tokyo). 2014;54:622-628.
• 5. Chumnanvejb S, Seresirikachorn K, Khawchareonporn N, Thanaviratananich S. Comparative outcomes of endoscopic transsphenoidal approach versus transcranial approach for pituitary adenomas: A meta-analysis.  Eur Arch Otorhinolaryngol. 2019;276(4):1077-1086.
• 6. Mundra RK, Bajaj M, Sharma S, Kataria P, Bhargava P. Influence of septal angle deviation on lateral nasal wall in patients of chronic rhinosinusitis. Indian J Otolaryngol Head Neck Surg. 2014;66(Suppl 1):248-252.
• 7. Villa CR, Pires FS, Arantes RMG, de Lima AB, Bento RF. Deviated septum and measurement of nasal septal angle of deviation. Int Arch Otorhinolaryngol. 2020;24(4):e431-e436.
• 8. Tao X, Wang C, Wu Z, Shi X. Clinical outcomes of endoscopic endonasal approach for pituitary adenoma resections: A series of 75 patients. Neurosurg Rev. 2021;44(3):1489-1498.
• 9. Lee H, Jang DW, Carrau RL, et al. Endoscopic endonasal transsphenoidal approach (EETA) for pituitary adenomas: a series of 869 patients from 2009 to 2020. J Neurosurg. 2021;134(5):1422-1430.
• 10. Ramadan HH, Allen GC. Septal deviation: A cause of difficult endoscopic sinus surgery. Am J Rhinol. 1997;11(5):365-370.
• 11. Chibbaro S, Di Rocco F, Makiese O, et al. Endoscopic endonasal transsphenoidal approach: Early and late complications in 400 patients. World Neurosurg. 2014;82(6S):S137-S144.
• 12. Patel KS, Eloy JA, Shukla PA, et al. Management of the deviated nasal septum in endoscopic skull base surgery. Laryngoscope. 2014;124(11):2444-2449.