Rhinoplasty Septorhinoplasty Septoplasty

1. Category: Prior Approval

Prior approval from the Integrated Care Board (ICB) will be required before any treatment proceeds in secondary care unless an alternative contract arrangement has been agreed with the ICB that does not necessitate the requirement of prior approval before treatment

2. Background

These procedures will not be funded for cosmetic reasons

3. Eligibility Criteria

These procedures will only be funded for the following conditions (with indications clearly documented for audit purposes)

• Correction of nasal deformity causing significant nasal blockage/obstruction
• Correction of nasal deformity associated with specific recognised facial congenital disorders.
• The patient does not complain of nasal obstruction but there is significant nasal deformity and there is a history of documented recent trauma (i.e. within 18 months of referral)
• There is a history of trauma causing nasal deformity in childhood

If the patient has had previous nasal surgery, revision will only be undertaken for functional reasons and not to improve appearance

Where treatment is sought for situations where patients require a cosmetic or reconstructive procedure to restore normal or near normal function or appearance as a direct consequence of trauma, burns, destructive surgery, cancer treatment or a recognised congenital malformation, reference should be made to Section 2.4 of the Treatments designed to improve Aesthetic Appearance policy

Nasal septum perforation

Presentations of nasal septum perforation must have a workup to ascertain aetiology including history and examination with further investigations as necessary

Treatment for nasal septal perforation will only be funded if the defect is any of the following:

• Symptomatic (whistling, blowing, crusting, bleeding, pain, excessive rhinorrhoea, snoring) regardless of size
• Iatrogenic in causation (endoscopy, medication induced) regardless of size.
• Neoplastic, regardless of size
• Where the causation is found to be medical in nature, regardless of size
• Conservative treatment may be offered to patients if the symptoms are not severe or if the defect is less than 1cm in size
• For defects larger than 1cm and the patient is symptomatic surgical treatment may be offered if:

o It is recommended by a specialist in ENT surgery

o Conservative treatments have failed to control the symptoms

For patients who DO NOT meet the eligibility criteria, the ICB will only consider funding the treatment if an Individual Funding Request (IFR) detailing the patient’s clinical presentation is submitted to the ICB

4. Guidance/References

Carrie, S. et al. (2023) ‘Clinical effectiveness of septoplasty versus medical management for nasal airways obstruction: Multicentre, open label, Randomised Controlled Trial’, BMJ [Preprint]. doi:10.1136/bmj-2023-075445.

Zelko, I. et al. (2022) ‘Primary cleft rhinoplasty: A systematic review of results, growth restriction, and avoiding secondary rhinoplasty’, Plastic & Reconstructive Surgery, 151(3).

Nguyen, H.L. et al. (2022a) ‘Use of septal cartilage in rhinoplasty to correct nasal deformity after unilateral cleft lip and palate surgery’, Clinical, Cosmetic and Investigational Dentistry, Volume 14, pp. 131–140. doi:10.2147/ccide.s364332.

Konstantinidis, I., Malliari, H. and Metaxas, S. (2011) ‘Nasal trauma: Primary reconstruction with open rhinoplasty’, Canadian Journal of Plastic Surgery, 19(3), pp. 108–110. doi:10.1177/229255031101900310.

Wong, C.-H. and Daniel, R.K. (2013) ‘Immediate functional and cosmetic open rhinoplasty following acute nasal fractures’, Aesthetic Surgery Journal, 33(4), pp. 505–515. doi:10.1177/1090820×13484466.

Kopacheva-Barsova, G. and Nikolovski, N. (2016) ‘Justification for rhinoseptoplasty in children – our 10 years overview’, Open Access Macedonian Journal of Medical Sciences, 4(3), pp. 397–403. doi:10.3889/oamjms.2016.080.