
High anterior septal deviation (HASD) is an underreported anatomic variant that can affect the decision to perform septoplasty for access during sinus surgery and ease of postoperative debridement. This study aims to 1) describe an objective method of assessing HASD and 2) explore its prevalence and implications for performing septoplasty. Computed tomography scans from 2014 to 2020 were retrospectively reviewed. Two independent observers measured the following concerning midline: distance to the septum (SDD), distance to the lateral nasal wall (LNW), and septal deviation angle (SDA). HASD is relatively common, and the methods described herein can reliably assess its dimensions. Measurements of SDD, SDD/LNW, and SDA exceeding cutoffs determined by this study may represent clinically significant deflections prompting consideration of septoplasty. In addition, these methods may aid in preoperative planning.
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