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Rhinoplasty / Septorhinoplasty / Septoplasty for nasal deformities – Information for GPs

Referral criteria / commissioning position

Consideration will not be given to cosmetic rhinoplasty.

Rhinoplasty may be considered medically necessary only in limited circumstance and where the clinical rationale is in accordance with the evidence base as follows; all cases require prior approval via the Individual Funding Request (IFR) panel:

  • when it is being performed to correct a nasal deformity secondary to congenital cleft lip and/or palate
  • upon individual case review, to correct chronic non-septal nasal airway obstruction from vestibular stenosis (collapsed internal valves) due to trauma, disease or congenital defect, when all of the following criteria are met:
  • airway obstruction will not respond to septoplasty and turbinectomy alone

AND

  • nasal airway obstruction is causing significant symptoms (e.g. chronic rhinosinusitis, difficulty breathing)

AND

  • obstructive symptoms persist despite conservative management for three months or greater, which includes where appropriate, nasal steroids or immunotherapy

AND

  • photos demonstrate an external nasal deformity

AND

  • there is an average 50% or greater obstruction of nostrils (e.g. 50% obstruction of both nostrils, or 75% obstruction of one nostril and 25% obstruction of other nostril, or 100% obstruction of one nostril), documented by endoscopy, CT scan or other appropriate imagine modality

There are, however, exclusions that need to be addressed, such as:

  • unstable mental health
  • unrealistic patient expectations
  • previous rhinoplasty within the last 9-12 months (applies only to major rhinoplasties)
  • poor perioperative risk profile
  • history of too many previous rhinoplasties, resulting in an atrophic skin-soft tissue envelope and significant scarring
  • nasal cocaine users

Investigations prior to referral

  • endoscopy, CT scan or other appropriate imagine modality

Information to include in referral letter

  • Details of how the patient meets the criteria
  • Treatments and interventions, current & past tried including the results,
  • Drug history (prescribed and non-prescribed)
  • Relevant past medical/surgical history
  • Current regular medication
  • BMI
  • Smoking status
  • Alcohol consumption
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