Impact of nasal septum deviation types on intraoperative mucoperichondrial perforation during septoplasty: A prospective cohort study

ObjectiveTo evaluate whether nasal septum deviation type is associated with intraoperative mucoperichondrial perforation during septoplasty.MethodsIn this prospective observational cohort at Bağcılar Training and Research Hospital (Istanbul, Türkiye), 133 adults undergoing septoplasty for nasal obstruction were classified by the Mladina system. The primary outcome was the occurrence of mucoperichondrial perforation during surgery; secondary outcomes were laterality and the largest tear dimension. Group differences across deviation types were analyzed with appropriate comparative statistics; two-sided <i>P</i> < 0.05 was considered significant.ResultsPerforation occurred in 63 of 133 patients (47.4%). Most tears were unilateral (98.4%); one patient (0.8%) had bilateral tears constituting a septal perforation. Perforation incidence differed by deviation type (<i>P</i> < 0.001): Type I, 5.9%; Type II, 31.3%; Type III, 37.8%; Type IV, 78.6%; Type V, 65.2%; Type VI, 60.0%; and Type VII, 83.3%. Mean tear size increased with deviation complexity, measuring ∼2-5 mm in Types I-III versus 6-8 mm in Types IV-VII (<i>P</i> < 0.05). Perforation frequency and size did not differ between surgeons.ConclusionNasal septum deviation morphology is strongly associated with the risk and extent of mucoperichondrial perforation during septoplasty. Patients with complex deviation patterns (Types IV-VII) have a substantially higher risk; recognizing these patterns preoperatively may inform counseling and encourage meticulous dissection strategies to reduce mucosal injury and the likelihood of septal perforation.