Endoscopic Septoplasty: Technical Notes and Treatment Outcomes of 156 Cases

Background: Endoscopic septoplasty is a minimally invasive alternative to conventional septoplasty, particularly for posterior septal deviations and complex deformities. This study aimed to describe our endoscopic septoplasty technique and to evaluate surgical outcomes, complications, and their association with different types of septal deviation.Methods: A retrospective analysis was performed on 156 patients who underwent endoscopic septoplasty by a single surgeon between March 2017 and September 2024. Patients were classified as having isolated cartilage deviation, combined cartilage and bony septal deviation, or isolated posterior septal spur. Demographic data, concomitant turbinate procedures, and postoperative complications were recorded. Associations between deviation type and complications were analyzed using Fisher’s exact test.Results: The study included 89 males and 67 females aged 18–62 years. Combined cartilage and bony septal deviation was identified in 76 patients (48.7%), isolated cartilage deviation in 32 (20.5%), and isolated posterior septal spur in 48 (30.7%). Postoperative complications occurred in 7 patients (4.4%), including septal hematoma (n=1), synechiae (n=3), and septal perforation (n=3). All complications occurred exclusively in patients with combined cartilage and bony deviation (7/76, 9.2%), while no complications were observed in the remaining patients (0/80), demonstrating a statistically significant association (p=0.006).Conclusion: Endoscopic septoplasty is a safe and effective technique with a low overall complication rate. However, combined cartilage and bony septal deviations are associated with an increased risk of postoperative complications, likely related to greater surgical complexity. Despite this, the endoscopic approach provides excellent visualization and favorable clinical outcomes when meticulous surgical technique is applied.