Open approach septoplasty and closed endonasal septoplasty: a comparative analysis of surgical outcomes, postoperative pain, and quality of life

Abstract

To evaluate and compare the clinical outcomes, postoperative pain, operative time, and quality-of-life improvements associated with open approach septoplasty (OAS) and closed endonasal septoplasty (CES) in patients undergoing surgery according to anatomical characteristics of the septal deviation. A prospective comparative study was conducted on 74 patients who underwent septoplasty between November 21, 2025, and February 28, 2026. Patients were allocated to OAS (n = 36) or CES (n = 38) according to the anatomical characteristics of the septal deviation. Nasal Obstruction Symptom Evaluation (NOSE) scores, Sino-Nasal Outcome Test-22 (SNOT-22) scores, Visual Analog Scale (VAS) for pain, operative time, and complications were evaluated. Follow-up assessments were performed at the first postoperative month with endoscopic examination. Caudal and high septal deviations were more frequent in the OAS group, whereas posterior and basal deviations were more frequent in the CES group (all p < 0.01). Both groups showed significant improvement in NOSE scores (p < 0.001) and SNOT-22 scores (p < 0.001) at the 1-month follow-up. The CES group demonstrated a significantly shorter operative time (32.2 ± 7.7 vs. 96.1 ± 16.1 min, p < 0.001) and lower postoperative pain scores (3.4 ± 1.1 vs. 5.5 ± 1.3, p < 0.001). However, the OAS group achieved a greater improvement in SNOT-22 scores (decrease of 28.5 ± 18.9 vs. 17.6 ± 18.3 points, p = 0.019). At the first postoperative month, SNOT-22 scores were significantly lower in the OAS group (12.1 ± 12.3 vs. 20.5 ± 16.4, p = 0.006). The overall postoperative complication rate was lower in the OAS group than in the CES group (8.3% vs. 26.3%, p = 0.04). While CES was associated with shorter operative time and lower early postoperative pain, patients treated with OAS demonstrated greater improvement in SNOT-22 scores at the 1-month follow-up. These findings reflect outcomes observed in anatomically selected patient groups and should be interpreted in the context of the study’s non-randomized design. These findings support an anatomically guided approach to surgical decision-making while emphasizing that the results should be interpreted within the limitations of this non-randomized prospective comparative study.