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

Abstract Background To compare the surgical outcomes, postoperative pain levels, operative time, and improvements in quality of life between open approach (OAS) and closed endonasal septoplasty (CES) techniques in patients with nasal septum deviation. Methods A prospective comparative study was conducted on 74 patients who underwent septoplasty between November 1, 2025, and February 28, 2026. Patients were divided into two groups according to the technique: OAS (n = 36) or CES (n = 38). 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. Results The OAS group had a higher likelihood of caudal and high septal deviations (p < 0.001, p = 0.004), while the CES group had a higher likelihood of posterior and basal deviations (p = 0.004, p = 0.001). 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 minutes, 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). OAS showed statistically significantly fewer complications compared to the CES technique (8.3% vs. 26.3%, p = 0.04). Conclusion While CES offers advantages in terms of operative time and early postoperative pain, OAS provides superior quality of life outcomes at the 1-month follow-up, especially in complex septal deviations. The choice of surgical technique should be individualized based on the characteristics of the deviation and patient expectations.