The relevance of rhinoplasty and septorhinoplasty from the commissioners
Reviewed by Madhup K Chaurasia

The rising costs of running the National Health Service and its overburdened resources has led to the constant monitoring of the low clinical value treatments. The operations of rhinoplasty and septorhinoplasty inevitably fall into this group and are subject to scrutiny by the clinical commissioning groups, of which there are 207 in England. This survey-based study aimed at finding out if there was any uniformity in the criteria adopted by these CCGs in commissioning these two operations. Two hundred commissioning groups replied to the questionnaires. About 90% of these commissioning groups allow surgery for nasal obstruction. However, there is no uniformity amongst these CCGs in terms of assessment of nasal obstruction, varying from subjective quantification of nasal obstruction to Nasal Obstruction Symptom Evaluation scale. Seventy percent are agreeable to cleft rhinoplasty and 25.5% allowed rhinoplasty for post-traumatic deformity even if there was no nasal obstruction. Ten percent required exceptional conditions to permit rhinoplasty. None of the CCGs allowed purely cosmetic rhinoplasty which is reasonable in the present economic climate. It is interesting that the issue of OSAS is not mentioned even though studies show that there is a significant reduction in the AHI after septoplasty or septorhinoplasty for nasal obstruction. It appears the issue in generally understood but the criteria used are very variable and need standardisation.

Clinical commissioning group criteria for rhinoplasty in England: survey of current guidance.
Ross EE, Anari S.
THE JOURNAL OF LARYNGOLOGY AND OTOLOGY
2018;132:591-5.