On the surgeon's behalf the MDU robustly denied breach of duty on the basis that the surgery had improved the patient's symptoms which were due to structural problems. It was made clear that the patient had been told that the external appearance of her nose would change, but that, at no stage, had she been advised that the surgery would improve her nasal congestion and nasal drip. These were unrelated to the structural problems in the nose but were due to an immunological imbalance in the nasal lining, of which the patient was aware. The crusting suffered by the patient was due to the staphylococcus infection, not the surgery.

The letter of response was served on the claimant's solicitors and no further correspondence was received.

The 35-year-old patient had a history of recurrent sinusitis, congestion and nasal blockage and had an angulated nasal septum. Her GP had tried conservative treatment using nasal sprays, all of which were ineffective.

The ENT consultant made three diagnoses - a marked septal deviation, nasal tip ptosis and seasonal allergies - all of which were causing persistent nasal obstruction and nasal drip. In the light of unsuccessful medical therapy, the consultant advised that surgery would be required to repair the deviated septum and elevate the nasal tip to correct the airflow. He emphasised to the patient that this was a functional procedure and not aesthetic.

The patient subsequently underwent an external septorhinoplasty operation in which a septal reconstruction and caudal replacement were carried out. The patient appeared to recover well from the operation.

On review five months after surgery, the patient was noted to have a staphylococcal infection in the nose and this was treated with oral antibiotics and mupirocin-based ointment. A rapid MRSA assessment had been performed on admission, but the infection had not been detected before surgery.

Some months later, the patient reported that although her nocturnal obstruction was now gone and her breathing was better, the left nasal passage felt blocked and she was concerned about a patch of numbness on the nasal tip. She sought a second opinion from another ENT consultant who noted that the nasal septum was in a reasonable position but that there was a minor prolapse of the left lower lateral cartilage which was slightly narrowing the nasal valve. Allergy profiling identified mild allergic rhinitis as the cause of her persisting rhinorrhoea.

A letter of claim was received alleging that the patient had not been fully consented, specifically with respect to the risk of numbness, aesthetic changes to the external appearance of the nose, and the potential for crusting to occur. The claimant also specifically alleged that she was not advised that the surgery might fail to improve her nasal congestion and nasal drip.

The claimant stated that if she had been warned of the possibility of numbness at the nasal tip, as well as a continuing nasal drip, she would not have undergone surgery. Her solicitors made an offer to settle for £2,500.

The MDU sought an expert opinion from an independent consultant ENT surgeon. Having investigated the matter, he said that the surgery had been carried out to a good standard and that if the member's factual evidence about his consenting procedure - that his usual practice was to discuss all the risks verbally with the patient in the consultations leading up to the surgery - was accepted, then the claim could be defended.