Download National Medical Policy

National Medical Policy
Subject:
Septoplasty, Turbinoplasty and Rhinoplasty
Policy Number:
NMP488
Effective Date*: March 2005
Updated:
May 2016
This National Medical Policy is subject to the terms in the
IMPORTANT NOTICE
at the end of this document
For Medicaid Plans: Please refer to the appropriate State’s Medicaid
manual(s), publication(s), citation(s), and documented guidance for
coverage criteria and benefit guidelines prior to applying Health Net Medical
Policies
The Centers for Medicare & Medicaid Services (CMS)
For Medicare Advantage members please refer to the following for coverage
guidelines first:
Use
X
x
Source
National Coverage Determination
(NCD)
National Coverage Manual Citation
Local Coverage Determination
(LCD)*
Article (Local)*
Other
None
Reference/Website Link
Cosmetic and Reconstructive Surgery:
Plastic Surgery:
http://www.cms.gov/medicare-coveragedatabase/search/advanced-search.aspx
Cosmetic and Reconstructive Surgery:
http://www.cms.gov/medicare-coveragedatabase/search/advanced-search.aspx
Use Health Net Policy
Instructions
 Medicare NCDs and National Coverage Manuals apply to ALL Medicare members
in ALL regions.
 Medicare LCDs and Articles apply to members in specific regions. To access your
specific region, select the link provided under “Reference/Website” and follow the
search instructions. Enter the topic and your specific state to find the coverage
determinations for your region. *Note: Health Net must follow local coverage
determinations (LCDs) of Medicare Administration Contractors (MACs) located
Septoplasty, Turbinoplasty and Rhinoplasty May 16
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

outside their service area when those MACs have exclusive coverage of an item
or service. (CMS Manual Chapter 4 Section 90.2)
If more than one source is checked, you need to access all sources as, on
occasion, an LCD or article contains additional coverage information than
contained in the NCD or National Coverage Manual.
If there is no NCD, National Coverage Manual or region specific LCD/Article,
follow the Health Net Hierarchy of Medical Resources for guidance.
Current Policy Statement
Septoplasty
Health Net, Inc. considers septoplasty (submucous resection), and associated middle
and inferior turbinate surgery with obstructive symptoms medically necessary to
correct internal deformities of the nose when any of the following are met:
1. To correct a deviated septum that produces chronic nasal obstruction and results
in significant medical disabilities from recurrent purulent sinusitis (more than 3
episodes per year), and both of the following:
a.
Must have evidence by CT scan of unremitting chronic or recurrent
sinusitis (e.g., clouding of sinuses, opacification of a sinus, air-fluid levels
or mucosal thickening with significant narrowing or obstruction of the
osteomeatal complexes); and
b.
Conservative therapy for a period of at least 3 months has failed to
alleviate or prevent episodes of sinusitis, including any of the following:



Appropriate antibiotics; OR
Nasal sprays, decongestants, antihistamines and/or topical
intranasal steroids; OR
Specific documented attempts to discontinue nasal irritants,
including smoking, occupational exposure, drugs, and inadequate
humidification.
2.
Septal deviation causing continuous nasal airway obstruction resulting in nasal
breathing difficulty not responding to 4 or more weeks of appropriate medical
therapy; or
3.
Recurrent epistaxis related to a septal deformity (4 or more significant episodes
per year) when conservative treatment measures have failed, such as avoidance
of medications affecting coagulation, adding humidity to the environment, and
cauterization; or
4.
Nasal septum trauma/perforation that resulted in new and significant functional
abnormalities; or
5.
Need for reconstruction after the removal of a benign or malignant tumor, or
surgical removal of part of a structurally significant part of the nasal septum; or
6.
When done in association with congenital malformations (e.g., cleft lip and/or
palate or any craniofacial deformity associated with severe, documented
functional impairment); or
Septoplasty, Turbinoplasty and Rhinoplasty May 16
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7.
Deviation is causing difficulty tolerating nasal continuous positive airway
pressure (CPAP) used to treat documented obstructive sleep apnea, and is
refractory to medical management; or
8.
Treatment of atypical, unilateral facial pain (Sluder’s Syndrome) caused by
septal contact points diagnosed by spray anesthesia of the nasal mucosa
Note: Health Net, Inc. considers laser-assisted septoplasty and radiofrequency
volumetric tissue reduction (RFVTR, Somnoplasty) of nasal turbinates (turbinate
coblation) medically necessary as the turbinate mucosa can be measurably and
reproducibly corrected using these tools instead of a knife.
Contraindications to performing septoplasty include, but are not limited to:
1.
2.
3.
4.
Large septal perforation;
Cocaine abuse;
Wegener granulomatosis;
Malignant lymphomas or monoclonal T- or B-cell proliferations.
Rhinoplasty
Rhinoplasty is considered not medically necessary when performed solely as a
cosmetic surgical procedure to shape the external contour of the nose (e.g., to
correct the appearance of a bulbous tip, an obvious bump or hook, or flared nostrils,
etc.) However, reconstructive rhinoplasty may be considered medically necessary to
correct deformities for functional improvement in any of the following explicit
situations:
1. Birth defects, e.g., congenital cleft lip and/or palate, and any other congenital
craniofacial deformity, when associated with severe functional impairment
2. Significant, documented nasal trauma with distortion within the 3 months prior to
surgery that significantly compromises the nasal airway and can only be
corrected by combined septo-rhinoplasty as opposed to delayed open reduction
of nasal and septal fracture, (CPT 21335).
3. Choanal atresia
4. Cancer
5. Septal infection with saddle deformity
6. When there is documentation that obstructed nasal breathing due to septal
deformity is not amenable alone to septoplasty due to significant loss of
structural integrity of the septum by external nasal traumatic deformity.
7. To correct chronic non-septal nasal airway obstruction from vestibular stenosis
(collapsed internal valves and/or nasal bone distortion significantly compromising
the nasal airways) due to trauma, disease, or congenital defect, when all of the
following are met:
Septoplasty, Turbinoplasty and Rhinoplasty May 16
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
Nasal airway obstruction is causing significant symptoms (e.g., chronic
rhinosinusitis, difficulty breathing); and

Obstructive symptoms persist despite conservative management for three
months or greater, which includes, where appropriate, nasal steroids or
immunotherapy; and

Photographs demonstrate an external nasal deformity, and

There is significant obstruction of one or both nares, documented by nasal
endoscopy, computed tomography (CT) scan or other appropriate imaging
modality, and

Airway obstruction will not respond to septoplasty and turbinectomy alone.
Note: Rhinoplasty is considered not medically necessary either alone or as an
integral part of a septoplasty when performed solely for the purposes of changing
appearance or in the primary treatment of obstructive sleep apnea, either performed
alone or routinely as part of another procedure such as uvulopalatopharyngo-plasty
(UPPP).
Documentation
Appropriate documentation should include:





Results of nasal endoscopy, CT or other appropriate imaging modality
documenting nasal obstruction;
If there is an external nasal deformity, preoperative photographs showing the
standard 4-way view - base of nose, frontal view and right and left lateral
views;
Relevant history of accidental or surgical trauma, congenital defect, or
disease (e.g., choanal atresia, nasal malignancy, abscess, septal infection
with saddle deformity, or congenital deformity);
Documentation of duration and degree of symptoms related to nasal
obstruction, such as chronic rhinosinusitis, mouth breathing, etc.;
Documentation of results of conservative management of symptoms
Codes Related To This Policy
NOTE:
The codes listed in this policy are for reference purposes only. Listing of a code in
this policy does not imply that the service described by this code is a covered or noncovered health service. Coverage is determined by the benefit documents and
medical necessity criteria. This list of codes may not be all inclusive.
On October 1, 2015, the ICD-9 code sets used to report medical diagnoses and
inpatient procedures have been replaced by ICD-10 code sets.
ICD-9 Codes
090.5
470
473.0 - 473.9
478.0
478.1
738.0
Other late congenital syphilis, symptomatic
Deviated nasal septum (deflected nasal septum, acquired)
Chronic sinusitis
Hypertrophy of nasal turbinates
Other diseases of nasal cavity and sinuses
Acquired deformity of nose
Septoplasty, Turbinoplasty and Rhinoplasty May 16
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748.0
748.1
749.0 - 749.04
749.20-749.25
754.0
780.57
784.7
802.0
802.1
Choanal atresia
Other congenital anomalies of nose
Cleft palate
Cleft palate with cleft lip
Certain congenital musculoskeletal deformities: of skull, face, and
jaw
Unspecified sleep apnea
Epistaxis
Fracture of nasal bones, closed
Fracture of nasal bones, open
ICD-10 Codes
A50.51-A50.59
G47.30
J32.0-J32.9
J34.2
J34.3
J34.81-J34.89
M95.0
Q30.0
Q30.1
Q30.2
Q30.8
Q35.1-Q37.9
Q67.0
Q67.1
Q67.2
Q67.3
Q67.4
R04.0
S02.2
Other late congenital syphilis, symptomatic
Sleep apnea, unspecified
Chronic sinusitis
Deviated nasal septum
Hypertrophy of nasal turbinates
Other specified disorders of nose and nasal sinuses
Acquired deformity of nose
Choanal atresia
Agenesis and underdevelopment of nose
Fissured, notched and cleft nose
Other congenital malformations of nose
Cleft lip and cleft palate
Congenital facial asymmetry
Congenital compression facies
Dolichocephaly
Plagiocephaly
Other congenital deformities of skull, face and jaw
Epistaxis
Fracture of nasal bones
CPT Codes
30400
30410
30420
30430
30435
30450
30460
30462
30465
30520
Rhinoplasty primary; lateral and alar cartilages and/or elevation
of nasal tip
Rhinoplasty, primary; complete, external parts including bony
pyramid, lateral and alar cartilages, and/or elevation of nasal tip
Rhinoplasty, primary; including major septal repair
Rhinoplasty, secondary; minor revision (small amount of nasal tip
work)
Rhinoplasty, secondary intermediate revision (bony work with
ostomies
Rhinoplasty, secondary major revision (nasal tip work and
osteotomies)
Rhinoplasty for nasal deformity secondary to congenital cleft lip
and/or palate including columellar lengthening; tip only
Rhinoplasty for nasal deformity secondary to congenital cleft lip
and/or palate including columellar lengthening; tip, septum,
osteotomies
Repair of nasal vestibular stenosis (e.g., spreader grafting, lateral
nasal wall reconstruction)
Septoplasty or submucous resection, with or without cartilage
scoring, contouring or replacement with graft
Septoplasty, Turbinoplasty and Rhinoplasty May 16
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HCPCS Codes
No specific codes
Scientific Rationale – Update May 2016
Camancho et al. (2015) completed a systematic review and meta-analysis in which
the relationship between nasal surgery and its effect on continuous positive airway
pressure (CPAP) device therapeutic treatment pressures on adults with obstructive
sleep apnea. Eighteen studies (279 patients) reported CPAP data after isolated nasal
surgery. Seven studies (82 patients) reported preoperative and postoperative mean
therapeutic CPAP device pressures and standard deviations, which reduced from 11.6
± 2.2 to 9.5 ± 2.0 centimeters of water pressure (cwp) after nasal surgery. Pooled
random effects analysis demonstrated a statistically significant pressure reduction,
with a mean difference of −2.66 cwp (95% confidence intervals, −3.65 to −1.67); P
< 0.00001. Eleven studies (153 patients) described subjective, self-reported data for
CPAP use; and a subgroup analysis demonstrated that 89.1% (57 of 64 patients)
who were not using CPAP prior to nasal surgery subsequently accepted, adhered to,
or tolerated it after nasal surgery. Objective, device meter-based hours of use
increased in 33 patients from 3.0 ± 3.1 to 5.5 ± 2.0 h in the short term (< 6 mo of
follow-up). Isolated nasal surgery in patients with obstructive sleep apnea and nasal
obstruction reduces therapeutic CPAP device pressures and the currently published
literature's objective and subjective data consistently suggest that it also increases
CPAP use in select patients.
Scientific Rationale – Update May 2015
Moxness and Nordgård (2014) sought to evaluate the outcomes of intranasal surgery
in patients with obstructive sleep apnea (OSA) in a single institution in Norway in an
observational cohort study. Fifty-nine patients with OSA and clinically significant
nasal obstruction underwent either septoplasty alone or septoplasty with
concomitant volume reduction of the turbinates from August 2008 until the end of
December 2010. Subjects were scheduled for sleep polygraphy before and 3 months
after treatment. In this observational single-centre cohort study we evaluated and
compared the effect of these two specific surgical procedures on sleep related
parameters. There was a significant reduction in the apnea-hypopnea index (AHI)
only in the group that had septoplasty with turbinate reduction (17.4, (SD 14.4) 11.7, (SD 8.2), p <0.01), and this effect was significantly better than in the group
treated with septoplasty alone. Other objective parameters remained unchanged.
Subjective assessments obtained with a postoperative questionnaire showed an
equally positive effect on diurnal sleepiness and nasal obstruction in both groups,
and a better effect on sleep quality in the combined treatment group. The effect of
nasal surgery on obstructive sleep apnea seemed to be greater when there were
indications for combined surgery of the inferior turbinates and the nasal septum,
compared to when there were indications for septoplasty alone
Scientific Rationale – Update April 2008
Septoplasty
(2000) The American Academy of Otolaryngology-Head and Neck Surgery (AAOHNS) states: “Septoplasty or submuccous resection, with or without cartilage
scoring, contouring or replacement with graft is indicated, with nasal airway
obstruction or difficult nasal breathing causing any of the following: mouth
breathing; snoring, sleep apnea, or recurrent sinus infections”. This is listed as one
Septoplasty, Turbinoplasty and Rhinoplasty May 16
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of the clinical indicators for septoplasty. Per the AAO-HNS the ‘Clinical Indicators for
Otolaryngology-Head and Neck Surgery’ are guidelines only. In no sense do they
represent a standard of care. The applicability of an indicator for a procedure, and/or
of the process or outcome criteria, must be determined by the responsible physician
in light of all the circumstances presented by the individual patient. Adherence to
these guidelines will not ensure successful treatment in every situation.
A deviated septum may cause one or more of the following:

Blockage of one or both nostrils; or

Nasal congestion, sometimes one-sided; or

Frequent nosebleeds; or

Frequent sinus infections; or

At times, facial pain, headaches, postnasal drip; or

Noisy breathing during sleep (in infants and young children).
(2007) Per the Institute for Clinical Systems Improvement (ICSI), septoplasty is
performed to straighten a deviated nasal septum, a cause of substantial nasal
obstruction. This procedure has a very high rate of success in improving the nasal
airway if the nasal septal deviation is the major etiology of the nasal obstruction.
Septoplasty may be considered medically necessary when there is documentation
that obstructed nasal breathing due to septal deformity or deviation is causing
difficulty tolerating nasal continuous positive airway pressure (CPAP) and it is
refractory to medical management. Septoplasty for obstructive sleep apnea may be
considered medically necessary when the medical criteria for septoplasty are met.
Sinusitis
Sinusitis represents one of the most common disorders in which antibiotic treatment
is given to the adult population, including cases of acute sinusitis, which is most
often initially viral.
The emergence of bacteria highly resistant to broad-spectrum antibiotics has forced
a modification regarding the treatment of upper respiratory infections. Antibiotics
should not be prescribed unless a bacterial infection is certain. The patient should be
educated about the rationale for this. Most cases of sinusitis would most likely
resolve with or without medical treatment. Sinusitis is usually treated, however, to
avoid potential complications and hasten recovery. The proximity of the paranasal
sinuses to the orbits and brain potentially allows infection to spread to these
locations.
(2001) Per the American Academy of Pediatrics, clinical practice guidelines for the
management of acute bacterial rhinosinusitis in children were published. Changes in
the antibiotic susceptibility patterns for the common pathogens causing both acute
and chronic rhinosinusitis warrant a re-evaluation and update. However, they note
that there are still insufficient data in the literature to develop evidence-based clinical
guidelines.
Septoplasty, Turbinoplasty and Rhinoplasty May 16
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The Academy of Pediatrics Clinical Practice Guideline on the ‘Management of
Sinusitis’ for the diagnosis and treatment of acute bacterial sinusitis in children
notes that areas for future research include the following:
 Determine the optimal duration of antimicrobial therapy for children
with acute bacterial sinusitis.
 Determine the causes and treatment of subacute and recurrent acute
bacterial sinusitis.
 Determine the efficacy of prophylaxis with antimicrobials to prevent
recurrent acute bacterial sinusitis.
 Performance of prospective, randomized, clinical trials, to determine
an outcome of treatment with antibiotics and adjuvant therapies
(mucolytics, antibiotics, decongestants, antihistamines, etc) in patients
with acute bacterial sinusitis.
 Determine the role of complementary and alternative medicine
strategies in patients with acute bacterial sinusitis by performing
systematic, prospective, randomized clinical trials.
 Assess the effect of the pneumococcal conjugate vaccine on the
epidemiology of acute bacterial sinusitis.
 Develop new bacterial and viral vaccines to reduce the incidence of
acute bacterial sinusitis.
(2006) There is an ongoing ClinicalTrials.gov Identifier: NCT00132275 to determine
the effectiveness of antibiotic treatment of children diagnosed to have acute sinusitis
on clinical grounds alone without the performance of sinus images and to evaluate
the response to antibiotic therapy or placebo. The estimated study completion date
was scheduled for September 2007, but this Clinical Trial has not been completed at
this time. There are also a number of other similar ongoing clinical trials.
Scientific Rationale - Initial
Nasal obstruction is one of the most common problems bringing a patient into a
physician's office, and septal deviation is a frequent structural etiology. There are
many potential causes for nasal obstruction. Blockage may occur when the lining of
the nose swells, or when there is a deformity of the cartilaginous or bony structures
that make up the framework of the nose. The two major components of the nasal
passages are the septum and the turbinates. The nasal septum is the part of the
nose that divides the right nasal cavity from the left nasal cavity and generally lies
directly in the center of the nose. In the inside of each nostril there are bony
projections called turbinates. Turbinates increase the surface area of the inside of the
nose aiding its air-filtering functions. There are three turbinates (inferior, middle, and
superior) on each side of the nose. The turbinates are lined with the nasal mucous
membranes which can shrink and swell dramatically to regulate nasal air resistance,
humidify the air and collect airborne particles on its surface to clean the air.
Septoplasty is an operation that corrects any defects or deviations of the nasal
septum. Rhinoplasty is surgery to reshape the nose to one that the patient finds
more desirable. When the septum is off-center or misaligned, septoplasty
(submucosal resection) is sometimes required to straighten the septum in order to
correct the breathing impairment that results from the misalignment. The nasal
passages can also be obstructed by enlarged turbinates. Chronic nasal obstruction
may also be associated with inferior nasal turbinate hypertrophy and turbinectomy is
often performed at the time of nasal septal surgery by many otolaryngologists.
Septoplasty, Turbinoplasty and Rhinoplasty May 16
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According to the American Society of Plastic Surgeons and the American Academy of
Otolaryngology, rhinoplasty that is performed as an integral part of a medically
necessary septoplasty is performed to improve nasal respiratory function and revise
structural deformities caused by birth defects (e.g., cleft nasal deformity, which may
be associated with cleft lip and/or cleft palate, oromaxillary fistulas, absent nose
development and nasal duplication) or acquired conditions (trauma, disease, ablative
surgery). Telescoping tearing and dislocation of the septum is a frequent occurrence
in closed nasal injuries. Dislocations most frequently occur at the junction between
the quadrangular cartilage and the perpendicular plate of the ethmoid bone. Failure
to address a malpositioned septum in nasal fracture reduction may lead to eventual
nasal obstruction.
The decision for septoplasty is not typically based solely on the degree of deviation
alone. It is the accompanying functional impairment in the form of obstructed nasal
breathing and any resulting conditions, such as sinusitis. Deviations in the septum
can alter normal airflow, which may result in mucosal changes. This interference in
airflow may cause middle or inferior turbinate abnormalities. Sinus drainage may
also be compromised by deviation of the septum and can result in recurrent or
chronic sinusitis. Generally, a case is considered refractory to medical management
when there has been a sufficient period of treatment with antibiotics for infections,
intranasal steroids and decongestants.
There may be situations when, although a septal deformity may not be causing
specific symptoms, its presence is preventing surgical access to other intranasal or
paranasal areas, such as the sinuses or turbinates. Septoplasty may be medically
indicated when it is being performed to allow surgical access to these areas so that a
medically appropriate surgery may be successfully performed. Septoplasty may be
performed as part of cleft repair/reconstructive surgery or for other craniofacial
anomalies. Septoplasty may be necessary in order to allow adequate access to a
posterior vessel that is causing recurrent epistaxis. Also, where a septal deformity is
causing abnormal air turbulence, severe mucosal drying and crusting may develop
which can lead to recurrent nosebleeds.
A review of the literature does not support the efficacy of rhinoplasty/septoplasty
surgery in the treatment of obstructive sleep apnea, either performed alone or
routinely as part of another procedure such as uvulopalatopharyngoplasty (UPPP).
The surgical procedures have not been tested by appropriate randomized controlled
trial methods. The limited number of studies contains biases related to small sample
size as well as limited follow-up and patient selection. There is no convincing
evidence that these procedures reduce the severity of sleep apnea, although there
are anecdotal reports that compliance with CPAP may be improved when this therapy
continues to be required post-operatively. Septoplasty may be considered medically
necessary when there is documentation that obstructed nasal breathing due to septal
deformity or deviation is causing difficulty tolerating nasal CPAP and is refractory to
medical management.
Review History
March 2005
January 2007
April 2008
Medical Advisory Council
Update. No policy revisions. Coding Updates.
Update. Revised policy to include documentation of obstructed
nasal breathing due to septal deformity or deviation, difficulty
Septoplasty, Turbinoplasty and Rhinoplasty May 16
9
May 2008
August 2008
May 2010
May 2011
May 2012
May 2013
May 2014
November 2104
May 2015
May 2016
tolerating nasal CPAP and refractory to medical management.
Reformatted policy statement to include a & b under #1.
Further describes degree of nasal obstruction under #8.
CA reconstructive surgery law added to Disclaimer.
Update. No revisions. Codes updated.
Update. Added Medicare Table with links to LCDs. No revisions.
Update. No Revisions.
Update – no revisions. Code updates
Update – no revisions. Code updates
Revised requirement for specific degree of obstruction and added
criterion for obstruction without sinusitis
Update – no revisions
Update – no revisions. Code updates
This policy is based on the following evidence-based guidelines:
1.
2.
3.
4.
5.
6.
7.
8.
9.
Institute for Clinical Systems Improvement (ICSI). Diagnosis and treatment of
obstructive sleep apnea in adults. 2007 Mar. 55 p.
American Academy of Allergy, Asthma and Immunology/American College of
Allergy, Asthma and Immunology/Joint Council of Allergy, Asthma and
Immunology. Parameters for the diagnosis and management of sinusitis. 1998
Dec.
American Academy of Otolaryngology-Head and Neck Surgery, Inc. Research.
NOSE Study Results, Otolaryngology-Head and Neck Surgery, Bulletin, 2003
September: 42-43.
American Academy of Otolaryngology-Head and Neck Surgery, Inc. Rhinoplasty.
1999 Clinical Indicators Compendium.
American Academy of Otolaryngology-Head and Neck Surgery, Inc. Septoplasty.
1999 Clinical Indicators.
American Society of Plastic Surgeons (ASPS). Policy Statements. Nasal Surgery.
Position Paper of the American Society of Plastic Surgeons. February 2000: 1-3.
American Society of Plastic and Reconstructive Surgeons. Nasal Deformity. Sep
1993 (Reviewed 1997)
American Society of Plastic Surgeons (ASPS). Nasal Surgery. Position Paper of
the American Society of Plastic Surgeons. Sep 1994: 4 pages.
American Academy of Pediatrics. Clinical Practice Guideline: Management of
Sinusitis. Pediatrics. Volume 108, Number 3. September 2001, pp 798-808.
References – Update May 2016
1.
2.
3.
4.
Camancho M, Riaz M, Capasso R, et al. The Effect of Nasal Surgery on
Continuous Positive Airway Pressure Device Use and Therapeutic Treatment
Pressures: A Systematic Review and Meta-Analysis. Sleep. 2015 Feb 1; 38(2):
279–286.
Hong SD, Lee NJ, Cho HJ, et al. Predictive factors of subjective outcomes after
septoplasty with and without turbinoplasty: can individual perceptual differences
of the air passage be a main factor? Int Forum Allergy Rhinol. Jul;5(7):616-21.
doi: 10.1002/alr.21508. Epub 2015 May 1.
Surowitz J, Lee MK, Most SP. Anterior septal reconstruction for treatment of
severe caudal septal deviation: Clinical severity and outcomes. Otolaryngol Head
Neck Surg. 2015;153(1):27-33.
Texeira J, Certa V, Chang ET, et al. Nasal Septal Deviations: A Systematic
Review of Classification Systems. Plast Surg Int. 2016.
Septoplasty, Turbinoplasty and Rhinoplasty May 16
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5.
6.
Varadharajan K, Sethukumar P, Anwar M, et al. Complications associated with
the use of autologous costal cartilage in rhinoplasty: A systematic review.
Aesthet Surg J. 2015;35(6):644-652.
Wee JH, Park MH, Oh S, et al. Complications associated with autologous rib
cartilage use in rhinoplasty: A meta-analysis. JAMA Facial Plast Surg.
2015;17(1):49-55.
References – Update May 2015
1.
2.
Moxness MH, Nordgård S. An observational cohort study of the effects of
septoplasty with or without inferior turbinate reduction in patients with
obstructive sleep apnea. BMC Ear Nose Throat Disord. 2014 Oct 21;14:11.
Ye T, Zhou B. Update on surgical management of adult inferior turbinate
hypertrophy. Curr Opin Otolaryngol Head Neck Surg. 2015 Feb;23(1):29-33.
Reference – Update May 2014
1.
2.
Banglawala SM, Gill M, Sommer DD, et al. Is nasal packing necessary after
septoplasty? A meta-analysis. Int Forum Allergy Rhinol. 2013;3(5):418-424.
Gioacchini FM, Alicandri-Ciufelli M, et al. The role of antibiotic therapy and nasal
packing in septoplasty. Eur Arch Otorhinolaryngol. 2013 Jun 5.
Reference – Update May 2013
1.
2.
3.
4.
Bezerra TF, Stewart MG, Fornazieri MA, et al. Quality of life assessment
septoplasty in patients with nasal obstruction. Braz J Otorhinolaryngol. 2012
Jun;78(3):57-62.
Haroon Y, Saleh HA, Abou-Issa AH. Nasal soft tissue obstruction improvement
after septoplasty without turbinectomy. Eur Arch Otorhinolaryngol. 2013 Feb 1.
Lawrence R. Pediatric septoplasy: a review of the literature. Int J Pediatr
Otorhinolaryngol. 2012 Aug;76(8):1078-81.
Sedaghat AR, Busaba NY, Cunningham MJ, Kieff DA. Clinical assessment is an
accurate predictor of which patients will need septoplasty. Laryngoscope. 2013
Jan;123(1):48-52.
References – Update May 2012
1.
2.
Bhattacharyya N. Clinical presentation, diagnosis, and treatment of nasal
obstruction. UpToDate. Updated February 2012.
Devars du Mayne M, Moya-Plana A, et al. Eur Ann Otorhinolaryngol Head Neck
Dis. 2012 Jan.
References – Update May 2011
1.
2.
3.
4.
Isaacson GC. Congenital anomalies of the nose. January 28, 2011.
Bhattacharyya N. Clinical presentation, diagnosis, and treatment of nasal
obstruction. February 10, 2011.
Baumann I. Septoplasty update. Laryngorhinootologie. 2010;89(6):373-384.
Jang YJ, Kwon M. Modified extracorporeal septoplasty technique in rhinoplasty
for severely deviated noses. Ann Otol Rhinol Laryngol. 2010;119(5):331-335.
References – Update May 2010
1.
2.
Hwang PH, Getz A. Acute sinusitis and rhinosinusitis in Adults. UpToDate.
January 7, 2010.
Chaaban M, Shah AR. Open Septoplasty: Indications and Treatment.
Otolaryngologic Clinics of North America.
Septoplasty, Turbinoplasty and Rhinoplasty May 16
11
3.
Bloom JD, Kaplan SE, Bleier BS, et al. Septoplasty Complications: Avoidance and
Management. Otolaryngologic Clinics of North America - Volume 42, Issue 3
(June 2009).
References – Update April 2008
1.
2.
Norman D, Clin Geriatr Med. 01-FEB-2008; 24(1): 151-65, ix.
Eisenberg G, Perez C, Hernando M, et al. Nasosinusal endoscopic surgery as
major out-patient surgery. Acta Otorrinolaringol Esp. 2008 Feb; 59(2):57-61.
3. Kappe T, Papp J, Rozsasi A, et al. Nasal conditioning after endonasal surgery in
chronic rhinosinusitis with nasal polyps.Am J Rhinol. 2008 Jan-Feb; 22(1):89-94.
4. Getz AE, Hwang PH. Endoscopic septoplasty. Curr Opin Otolaryngol Head Neck
Surg. 2008 Feb; 16(1):26-31.
5. Ozlugedik S, Nakiboglu G, Sert C, et al. Numerical study of the aerodynamic
effects of septoplasty and partial lateral turbinectomy. Laryngoscope. 2008 Feb;
118(2): 330-4.
6. Williamson IG, Rumsby K, Benge S, et al. Antibiotics and Topical Nasal Steroid
for Treatment of Acute Maxillary Sinusitis. A Randomized Controlled Trial. JAMA.
2007; 298(21):2487-2496.
7. Lindbaek M. Acute Sinusitis. To Treat or Not to Treat? JAMA. Vol. 298 No. 21,
December 5, 2007. 298(21):2543-2544.
8. Rakel: Textbook of Family Medicine. 7th Edition. 2007
9. Current Allergy and Asthma Group. 1529-7322. 1534-6315. Issue Volume 6,
Number 6 / November, 2006, DOI 10.1007/s11882-006-0029-0, Pages 508-512
10. Clinical Trials. Gov. A Service of the US National Institute of Health. Guidelines
for Acute Sinusitis. Available at:
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%22&recr=open&rank=14&show_desc=Y#desc
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11. Nowak C, Bourgin P, Portier F, et al. Nasal obstruction and compliance to nasal
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12. Durr DG. Endoscopic septoplasty: technique and outcomes. J Otolaryngol. 2003
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14. Dinis PB, Haider H. Septoplasty: long-term evaluation of results. Am J
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15. Collet S, Bertrand B, Cornu S, Eloy P, Rombaux P. Is septal deviation a risk
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Principles of Appropriate Antibiotic Use for Rhinosinusitis in Adults: Background.
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18. Meyers S, Rohrer T, Grande D. Use of Dermal Grafts in Reconstructing Deep
Nasal Defects and Shaping the Ala Nasi. Dermatol Surg 2001 Mar;27(3):300-5.
19. Mulliken JB, Burvin R, Farkas LG. Repair of Bilateral Complete Cleft Lip:
Intraoperative Nasolabial Anthropometry. Plast Reconstr Surg 2001
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21. Snow V, Mottur-Pilson C, Hickner JM. Principles of Appropriate Antibiotic Use for
Acute Sinusitis in Adults. Ann Intern Med 2001 Mar;134(6):495-7.
22. Bateman N, Jones NS. Retrospective Review of Augmentation Rhinoplasties
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23. Berger G, Hammel I, Berger R, Avraham s, Ophir D. Histopathology of the
Inferior Turbinate with Compensatory Hypertrophy in Patients with Deviated
Nasal Septum. Laryngoscope 2000 Dec;110(12):2100-5.
24. Boenisch Mink A. Clinical and Histological Results of Septoplasty with a
Resorbable Implant. Arch Otolaryngology Head Neck Surg 2000
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25. Fedok FG, Ferraro RE, Kingsley CP, Fornadley JA. Operative Times,
Postanesthesia Recovery Times, and Complications during Sinonasal Surgery
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27. Mamikoglu B, Houser S, Akbar I, Ng B, Corey JP. Acoustic Rhinometry and
Computed Tomography Scans for the Diagnosis of Nasal Septal Deviation, with
Clinical Correlation. Otolaryngol Head Neck Surg 2000 Jul;123(1 Pt 1):61-8.
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Otolaryngol
30. Head Neck Surg 2000 Feb; 122(2): 228-32
31. Hwang PH, McLaughlin RB, Lanza DC, Kennedy DW: Endoscopic septoplasty:
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120(5): 678-82
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Management of Rhinosinusitis in Children: Consensus Meeting, Brussels,
Belgium, September 13, 1996. Archives of Otolaryngology Head Neck Surg
1998 Jan;124(1):31-4.
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Sinus Disease in Relation to the Deviated Septum. The Journal of
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