DNS — Deviated Nasal Septum

A 35-year-old woman presents with a 2-year history of left-sided nasal obstruction and recurrent left-sided sinusitis. She reports that her symptoms began after a nasal trauma during a motor vehicle accident. On nasal endoscopy, the nasal septum is deviated to the left with the apex at the level of the middle turbinate. The left maxillary and ethmoid sinuses show mucosal edema and purulent secretions. CT scan confirms a left-deviated septum with contact point at the middle turbinate and opacification of the left maxillary and ethmoid sinuses. She has been on topical nasal steroids and saline irrigations for 8 weeks without significant improvement. What is the most likely pathophysiological mechanism linking the DNS to recurrent sinusitis?

A 28-year-old male presents to the ENT clinic with a 3-year history of persistent nasal obstruction, worse on the left side. He reports frequent headaches localized to the left frontal region and occasional epistaxis. On anterior rhinoscopy, the nasal septum is markedly deviated to the left, with the deviated portion touching the lateral nasal wall. Nasal endoscopy reveals contact of the septal deviation with the left lateral nasal wall and middle turbinate. CT scan of the paranasal sinuses shows a C-shaped septal deviation with contact point at the level of the middle turbinate. The patient has failed conservative management with nasal steroids and antihistamines for 6 months. What is the most appropriate next step in management?