Nasal septal angle deviation: effect on lateral wall in nasal obstruction
Keywords:Chronic rhinosinusitis, CT scan PNS, Lateral nasal wall, Nasal septal deviation, Septal angle
Background: Deviation of the nasal septum (DNS) refers to the convexity of the septum to one side disturbing the nasal physiology with obstructed nasal breathing leading to lateral nasal wall abnormalities and paranasal sinuses (PNS) mucosal disease. Knowledge of nasal morphological parameters plays an important role in planning successful nasal surgery. Our aim was to evaluate the angle of septal deviation (ASD) on CT scan and study its influence on the lateral nasal wall abnormalities and PNS mucosal disease.
Methods: A prospective cross-sectional observational study was conducted on 130 patients with clinical evidence of DNS and chronic sinusitis. The direction and severity of DNS was recorded on CT scan along with evaluation of lateral nasal wall and sinus mucosal abnormalities.
Results: Increasing ASD had statistically significant correlation with the lateral nasal wall abnormalities, most commonly, contralateral middle and inferior turbinate hypertrophy (p-value <0.0001). No significant association was found with the incidence of ipsilateral or contralateral osteomeatal complex (OMC) obstruction and sinus mucosal disease.
Conclusions: The direction and severity of septal deviation has significant impact on contralateral middle and inferior turbinate hypertrophy. The analysis of these ancillary pathologies can be of great help to the surgeon in better management of patients with nasal obstruction.
Gray LP. Deviated nasal septum. Incidence and etiology. Ann Otol Rhinol Laryngol Suppl. 1978;87:3-20.
Harugop AS, Mudhol RS, Hajare PS, Nargund AI, Metgudmath VV, Chakrabarti S. Prevalence of nasal septal deviation in new-borns and its precipitating factors: a cross-sectional study. Indian J Otolaryngol Head Neck Surg. 2012;64:248-51.
Mohebbi A, Ahmadi A, Etemadi M, Safdarian M, Ghourchian S. An epidemiologic study of factors associated with nasal septum deviation by computed tomography scan: a cross sectional study. BMC Ear Nose Throat Dis. 2012;12:15.
Stallman JS, Lobo JN, Som PM. The incidence of concha bullosa and its relationship to nasal septal deviation and paranasal sinus disease. Am J Neuroradiol. 2004;25:1613-8.
Moorthy P, Kolloju S, Madhira S, and Jowkar A. Clinical Study on Deviated Nasal Septum and Its Associated Pathology. Inter J Otolaryngol Head Neck Surg. 2014;3:75-81.
Elahi MM, Frenkiel S, Fageeh N. Paraseptal structural changes and chronic sinus disease in relation to the deviated septum. J Otolaryngol. 1997;26:236-240.
Madani SA, Hashemi SA, Modanluo M. The incidence of nasal septal deviation and its relation with chronic rhinosinusitis in patients undergoing functional endoscopic sinus surgery. J Pak Med Assoc. 2015;65:612-4.
Shpilberg KA, Daniel SC, Doshi AH, Lawson W, Som PM. CT of anatomic variants of the paranasal sinuses and nasal cavity: poor correlation with radiologically significant rhinosinusitis but importance in surgical planning. AJR Am J Roentgenol. 2015;204:1255-60.
Demir D, Asil K, Guven M, Kayabaşoglu G, Yılmaz MS. Assessment of the correlation between nasal septal deviation and compensatory hypertrophy of the middle turbinate. Euro Arch Otorhinolaryngol. 2015;272:2847-51.
Orhan I, Aydın S, Ormeci T, Yılmaz F. A radiological analysis of inferior turbinate in patients with deviated nasal septum by using computed tomography. Am J Rhinol Allergy. 2014;28:68-72.
Mundra RK, Gupta Y, Sinha R, Gupta A. CT Scan Study of Influence of Septal Angle Deviation on Lateral Nasal Wall in Patients of Chronic Rhinosinusitis. Indian J Otolaryngol Head Neck Surg. 2014;66:187-90.
Poorey VK, Gupta N. Endoscopic and computed tomographic evaluation of influence of nasal septal deviation on lateral wall of nose and its relation to sinus diseases. Ind J Otolaryngol Head Neck Surg. 2014;66:330-5.
Yousem DM, Kennedy DW, Rosenberg S. Ostiomeatal complex risk factors for sinusitis: CT evaluation. J Otolaryngol. 1991;20:419-24.
Calhoun KH, Waggenspack GA, Simpson CB, Hokanson JA, Bailey BJ. CT evaluation of the paranasal sinuses in symptomatic and asymptomatic populations. Otolaryngol Head Neck Surg. 1991;104:480-3.
Bolger WE, Butzin CA, Parsons DS. Paranasal sinus bony anatomic variations and mucosal abnormalities: CT analysis for endoscopic sinus surgery. Laryngoscope. 1991;101:56-64.
Kanwar SS, Mital M, Gupta PK, Saran S, Parashar N, Singh A. Evaluation of paranasal sinus diseases by computed tomography and its histopathological correlation. J Oral Maxillofac Radiol. 2017;5:46-52.
Babbel RW, Harnsberger HR, Sonkens J, Hunt S. Recurring patterns of inflammatory sinonasal disease demonstrated on screening sinus CT. AJNR Am J Neuroradiol. 1992;13:903-12.
Mamatha H, Shamasundar NM, Bharathi MB, Prasanna LC. Variations of ostiomeatal complex and its applied anatomy: a CT scan study. Ind J Sci Technol. 2010 Aug 1;3(8):904-7.
Milczuk HA, Dalley RW, Wessbacher FW, Richardson MA. Nasal and PNS anomalies in children with chronic sinusitis. Laryngoscope. 1993;103(3):247-52.