The case involves a 24-year-old patient with nasal blockage who underwent septoplasty and turbinate surgery that resulted in injuries. The patient presented to the otolaryngologist with complaints of nasal obstruction associated with snoring and chronic nose bleeds. Upon physical examination he was noted to have a grossly deviated nasal septum and enlarged turbinates. Both findings compromised nasal airflow. The otolaryngologist’s diagnosis was a nasal airway obstruction from a deviate septum associated with enlarged turbinate. The patent underwent surgery for a septal repair with a reduction of the enlarged turbinate. The patient returned 8 months after the operation, complaining of chronic headaches along with facial pressure. The patient was concerned about the deviated septum, but the otolaryngologist said it was most likely sinusitis, and placed him on antibiotics. However, the patient returned more than a month later with no improvement in his symptoms. His otolaryngologist then recommended a CT scan of the sinuses which showed inflamed sinuses as well as severe septal deviation in the area of the initial surgery.
Question(s) For Expert Witness
- 1. Do you have extensive experience performing septoplasty and turbinate surgery?
- 2. Please explain the complications that can arise from not conducting testing (MRI,CT SCAN, etc.) when a deviated septum is detected?
Expert Witness Response E-006344
Septoplasty and turbinate surgery are the most common procedures that I perform. I perform around 4 septoplasties per week. I think the issue here is whether the patient received any medical treatment prior to the septoplasty and whether she was encouraged to follow up after surgery. Imaging is rarely obtained in the case of deviated septums, but in certain cases it depends upon the patient.
Expert Witness Response E-009010
This case falls right within my areas of expertise and I would be glad to review. I perform septoplasty and turbinate surgery once or twice a week. In the field of nasal studies there is a lot of variation in terms of what is available and what is standard. Testing is not mandatory in all cases as it often depends on the degree of deviation. In this case I would have performed a visual inspection as a first step to determine if further testing is needed.