Endoscopic and computed tomographic evaluation of influence of nasal septal deviation on lateral wall of nose and its relation to sinus diseases

Retrospective analysis of pathological changes in the maxillary sinus with CBCT

The aim of this study is to examine the frequency of maxillary sinus pathologies and their relationship with each other using cone beam computed tomography (CBCT) and to make a new grade according to the number of affected walls. 1000 maxillary sinuses of 500 patients with CBCT images were included in the study. Anatomical variations and pathological formations of the maxillary sinuses were examined. Images were evaluated for the presence of flat, polypoidal, partial and generalized mucosal thickening, partial and total opacification, polyps and mucous retention cysts. Maxillary sinus pathologies were graded according to the number of walls affected. In the examined CBCT images, no pathology was found in 54.2% of the maxillary sinuses, while pathology was observed in 45.8%. The most common sinus pathologies were mucous retention cyst (12.3%) and polypoidal thickening (12.2%). While pneumatization, ostium obstruction, and the presence of sinus-related roots were associated with sinus pathology, no relationship was found with nasal septum deviation and the presence of septa. Before dental implant and sinus surgery applications, the presence of sinus pathologies and their relationship with anatomical variations can be evaluated with CBCT, a three-dimensional technique, and complications such as sinus membrane perforation, infection, failure to break the bone window due to the presence of antral septa, graft loss and oroantral fistula formation can be reduced.

Nasal septal anatomical variations among Saudi population and their possible coincidence with sinusitis: a computed tomography scan study

The nasal septum is a crucial supporting factor for the nasal cavity and may develop several anatomical variants including septal deviation, spur and pneumatization. These variants could be associated with a higher incidence of sinusitis due to structural and functional alterations. So, the aim of this study was to assess the prevalence of nasal septal deviation (NSD), nasal septal spur (NSS) and nasal septal pneumatization (NSP) among the Saudi adult population and their links with the incidence of sinusitis by using computed tomography (CT). A retrospective study was achieved over a twenty-two months period on 681 adult Saudi subjects (420 males and 261 females) aged 20 years or older, referred for coronal CT evaluation of the paranasal sinuses. NSD and NSS were significantly more prevalent in males than females (80.0% vs. 67.4% respectively for NSD, and 34.5% vs. 24.9% respectively for NSS), while there was no statistical difference in frequency of NSP regarding gender (P=0.670). The incidence of sinusitis was significantly higher in presence of NSD and/or NSS (P<0.001 for both). On the contrary, NSP was not associated with a significant increase in the prevalence of sinusitis (P=0.131). In conclusion, NSD and NSS are more prevalent in males than females among the Saudi population with no statistical difference between both genders regarding the presence of septal pneumatization. Furthermore, sinusitis is more prevalent with the occurrence of NSD and NSS, and not related to the incidence of NSP.

Sinusitis and its association with deviated nasal septum at a tertiary hospital: A retrospective study

Objectives

Sinusitis is common and deviated nasal septum (DNS) is a frequent anatomical variant in the paranasal sinuses (PNS). Whether DNS can cause sinusitis has been a subject of debate. This study determined the rate of sinusitis and its possible association with DNS and other factors in patients attending King Abdulaziz University Hospital (KAUH).

Methods

We conducted a hospital-based cross-sectional study and reviewed the electronic health records of KAUH retrospectively. We recruited all patients aged ≥18 years who were referred to the Diagnostic Radiology Department for a PNS computed tomography scan from January 2018 to December 2020. Descriptive and inferential statistics were calculated.

Results

A total of 676 participants met the eligibility criteria, with a mean (SD) age of 38.9 (13) years. Sinusitis was present in 47.5% of patients, 54.8% ofwhich were males. Patients aged 31–40 years suffered sinusitis more than the other age groups.Approximately three-fourths (75.1%) of the total sample had DNS, and 51.3% of them had sinusitis. Those who did not have DNS but had sinusitis were 27.8%.There were significant associations between sinusitis and both sex (P <0.001) and age (P <0.05). Patients with DNS were approximately three times more likely to have sinusitis than those without DNS (OR =2.74, 95% CI:1.86–4.04; P <0.001).

Conclusion

Almost half of the patients had sinusitis, and three-fourths had DNS. Sex, age, and DNS are possible factors associated with sinusitis. Assessing the presence of DNS and correcting it, if possible, is recommended to prevent the occurrence of sinusitis.

Deviated Nasal Septum a Risk Factor for the Occurrence of Chronic Rhinosinusitis

The aim of this review article is to determine whether a deviated nasal septum (DNS) is a potential risk factor for the occurrence of chronic rhinosinusitis (CRS). Nasal septal deformities include spur, deviated nasal septum, thickening, and dislocation. Deformities of the nose tip and columella are examples of external deformities, together with the deviated part of either cartilage or both the bony and cartilage part of the dorsum of the nose. Various symptoms of chronic rhinosinusitis include nasal obstruction, nasal or post-nasal drainage, facial pain and pressure, and smell disturbances. For a long time, the deviation of the nasal septum is related to the pathogenesis, progression, and severity of chronic rhinosinusitis. Mechanisms involving mechanical and aerodynamics theory may be used to explain this relationship. Etiology in the occurrence of CRS are allergy, asthma, tooth Infection, immunodeficiency, mucociliary disorders, anatomical irregularities like DNS, concha bullosa, septum spurring, or an expanded cystic middle turbinate or prominent agger nasi cells that compromise the osteomeatal complex. The computed tomography (CT) scan imaging of the nasal cavity and paranasal sinuses has dramatically improved especially since the use of coronary CT scans. These scans make it simple to find even minute changes and abnormalities in bony structures and mucosal pathologies. An increase in the angle of DNS is significantly linked to specific disease patterns in the osteomeatal complex. This review shows that not all subtypes of DNS always result in the development of CRS. Only extremely severe DNS appears to contribute to the etiology of CRS.

Does Degree of Nasal Septal Deviation Measured with CT PNS have a Role in Management of Deviated Nasal Septum?

Deviated nasal septum is one of the most commonly encountered nasal anatomical abnormalities. Various studies showed that deviated nasal septum results in the osteo-meatal complex disease and compensatory turbinate hypertrophy. But only a few studies described the association between type and degree of angle of deviated nasal septum and measured the angle of septal deviation and explore its effect in causation of nasal symptomatology. Hence, this study was undertaken with the aim to study the relation between type and degree of septal deviation with nasal symptomatology and to measure the degree of septal deviation. This was an observational study and data collection was done from August 2017 to August 2019. A total 52 patients with symptomatic deviated nasal septum were studied. Higher septal deviation caused symptoms in 73% of cases and severe degree of angle of septal deviation caused symptoms in 63% of cases. High and severe deviated nasal are more associated with nasal symptoms. Therefore, we could derive a correlation between the cases with higher septal deviation and incidence of nasal symptoms.

Histomorphometric evaluation of different graft associations for maxillary sinus elevation in wide antral cavities: a randomized controlled clinical trial

OBJECTIVES

Pneumatization of the maxillary sinus can make it difficult, if not impossible, to install osseointegrated implants, and undertake their eventual functional rehabilitation, which may ultimately require regenerative techniques to achieve. This randomized controlled study proposed conducting a histological evaluation of the behavior of different graft materials in wide maxillary sinuses, at a height of 8 to 10 mm from the alveolar ridge, combined with bone remnants less than 3mm.

MATERIALS AND METHODS

Thirty-six patients underwent a sinus elevation procedure through the lateral window. The sinuses were randomly filled with the following materials (n=12/group): group 1, xenogenic bone + autogenous bone (ratio 70:30, respectively); group 2, xenogenic bone + L-PRF; and group 3, xenogenic bone. At 8 months, bone biopsies of engrafted sites were harvested and analyzed histomorphometrically in order to quantify newly formed bone tissue.

RESULTS

The results showed a greater area of newly formed bone for G1, averaging 2678.37 (1116.40) μm², compared with G2 at 984.87 (784.27) μm², and G3 at 480.66 (384.76) μm² (p < 0.05). Additionally, fewer xenogenic bone particles and a large amount of connective tissue were observed in G2.

CONCLUSIONS

In maxillary sinuses with large antral cavities, autogenous bone combined with xenogenic bone seems to demonstrate better graft remodeling and improve bone formation, compared with the addition of L-PRF.

CLINICAL RELEVANCE

L-PRF produces few advantages regarding new bone formation in the wide maxillary sinuses.

TRIAL REGISTRATION

Brazilian Clinical Trials Registry (REBEC) number RBR-2pbbrvg.

Comparison of the Type and Severity of Nasal Septal Deviation between Chronic Rhinosinusitis Patients Undergoing Functional Endoscopic Sinus Surgery and Controls

Objectives

Some correlations have been proposed between chronic rhinosinusitis (CRS) and type and severity of nasal septal deviation. This study sought to compare the type and severity of nasal septal deviation between CRS patients undergoing functional endoscopic sinus surgery (FESS) and asymptomatic controls using cone-beam computed tomography (CBCT).

Materials and Methods

This prospective case-control study evaluated 49 CRS patients who did not respond to pharmaceutical therapy and were candidates for FESS and 49 asymptomatic controls. All participants underwent CBCT and were inspected for septal deviation type and severity. Data were analyzed by the independent t-test and chi-square test.

Results

The study population comprised of 58.25% males and 41.8% females, with a mean age of 33.74 ± 11.78 years. Significant correlations were noted between the presence of CRS and severity of septal deviation (P=0.007). Type of septal deviation had no significant correlation with the presence of CRS (P=0.443).

Conclusion

Patients with CRS have significantly more severe nasal septal deviation. However, type of septal deviation is not correlated with CRS.

Associations between the severity of nasal septal deviation and nasopharynx volume in different ages and sexes: a cone-beam computed tomography study

Background

Nasal septum deviation (NSD) can cause serious anatomical and clinical complications. It can change the breathing pattern and thus alter the anatomy of the airway structures. Despite its importance, the association between NSD with the nasopharynx volume (NPV) has not been assessed before. Therefore, we aimed to investigate it for the first time.

Methods

Archival CBCTs of 202 patients older than 17 years and without any history of trauma or pathology of the nasopharynx and without any orthodontic/orthognathic treatments were evaluated (129 women, 73 men, mean age: 36.24 ± 14.61 years). All included CBCTs must have been taken with a 12 × 8 field of view and fully covered the nasopharynx areas. The extent of NSD (°) and NPV (mm³) were measured. NSDs were categorized as mild (NSD ˂ 9°), moderate (9 ≤ NSD ≤ 15°), and severe (NSD ˃ 15°). Associations between sex, age, NSD, and nasopharynx volume were assessed using independent-samples t test, chi-square, one-way ANOVA, Tamhane post hoc test, Pearson and point-biserial correlation coefficients, and multiple linear regressions (α = 0.05).

Results

Mean NSDs were 11.27 ± 4.69° (range 1–19.5), 11.58 ± 4.63°, and 10.70 ± 4.76° in the sample, females, and males, respectively (P > 0.05). Of females, 27.9%, 40.3%, and 31.8% had mild, moderate, and severe NSDs. These were 35.6%, 39.7%, and 24.7% in males (P > 0.05). Mean NPVs were 4.88 ± 1.49, 4.80 ± 1.43, and 5.04 ± 1.60 mm³ in the sample, females, and males, respectively (P > 0.05). Mean NPVs were 6.41 ± 1.21, 4.87 ± 0.73, and 3.30 ± 0.65 mm³ in mild, moderate, and severe NSD groups (all P values = 0.000). Mean ages were 27.06 ± 6.49, 29.80 ± 9.64, and 54.73 ± 8.45 years in mild, moderate, and severe NSD groups (severe group being older than the other two groups, P = 0.000). NSD was strongly, negatively correlated with NPV (R = − 0.793, P = 0.000). Sex was not correlated with NPV or NSD (P ≥ 0.189). Age was negatively and positively correlated with NPV and NSD, respectively (P = 0.000). Modeling NSD (β = −0.776, P = 0.000) as a predictor for NPV rendered age effect insignificant (P > 0.05).

Conclusions

It was found, for the first time, that the more deviated the nasal septum, the smaller the nasopharynx volume. Aging might increase NSD and through it, reduce the nasopharynx volume. Sex might not affect NSD or NPV.

[The effect of various types of nasal septal deviation, concha bullosa and hypertrophic inferior turbinate on the development of sinusitis]

OBJECTIVE

To determine the impact of various types of unilateral nasal septum deviation (NSD), concha bullosa (CB) and hypertrophic inferior turbinate (HIT) on the development of sinusitis.

MATERIAL AND METHODS

This study was conducted in the Irkutsk State Medical University and the Irkutsk City Clinical Hospital No. 1 from October 2017 to November 2018. By continuous sampling retrospective analysis of 1300 protocols of paranasal sinuses MSCT of adult patients was performed. We used MSCT scanners Somatom Emotion 16 Siemens and GE BrightSpeed 16. The studies were carried out on the patients lying on the back with the subsequent reconstruction on a graphical station in the coronal and axial projections using the slices around 1 mm in the thickness. Inclusion criteria: unilateral or absence NSD. Exclusion criteria: bilateral NSD, chronic polyposis or allergic rhinitis. We have analyzed 272 protocols: 70 without NSD and 172 with unilateral NSD, on the right side - 89 (52%) and on the left - 83 (48%). 108 (44.6%) patients were male and 134 (55.4%) were female with average age 38.5±12 years. All patients were divided into 4 groups by R. Mladina' classification (1987): with NSD types 1, 2, 3, and 5. The results were evaluated using the Yates corrected chi-square and the Fisher's exact test by Statistica 10.0.

RESULTS

There were 34 patients with NSD type 1: 12 with sinusitis; 9 had CB: 6 with sinusitis, 3 without it; HIT was in 27 cases: 33% with sinusitis, 67% without it. There were 69 patients with NSD type 2: 12 had sinusitis; 22 had CB: 5 with sinusitis, 17 without it; HIT was in 42 cases: 26% with sinusitis, 74% without it. There were 43 patients with NSD type 3: 26 had sinusitis; 15 had CB: 6 with sinusitis, 9 without it; 30 had HIT: 57% with sinusitis, 43% without it. There were 26 patients with NSD type 5: 11 had sinusitis; 9 had CB: 3 with sinusitis, 6 without it; 24 had HIT: 42% with sinusitis, 58% without it. NSD type 2 was statistically significant prevailed in patients without sinusitis (p=0.000005); NSD type 3 (p=0.03) and the combination of NSD type 1 with contralateral CB (p=0.04) prevailed in patients with sinusitis.

CONCLUSION

NSD type 3 (by R. Mladina), as well as the combination of type 1 with contralateral CB are have influence to the development of sinusitis. CB and HIT are statistically significant prevailed on the contralateral side to unilateral NSD, but do not affect to development of sinusitis.

The Relationship Between Nasal Septal Deviation and Paranasal Pneumatization

OBJECTIVE

To investigate the impact of the presence and the severity of the nasal septal deviation (NSD) on the paranasal pneumatization.

METHODS

Initially, the deviated and contralateral sides was compared to evaluate the impact of the presence of NSD on pneumatization. Then, NSD classification groups were categorized according to the severity of deviation degree; 1: mild (<9°), 2: moderate (9°-15°), and 3: severe (>15°). Pneumatization of all paranasal sinuses, osteomeatal complex (OMC), frontoethmoid recess (FER) and variant structures were compared according to the NSD classification groups separately both for the deviated and the contralateral sides.

RESULTS

Although there was no statistically significant difference in pneumatization of the paranasal sinuses between the deviated and contralateral sides, a significant difference was observed in OMC and FER diameters. In the deviated side, there was statistically significant difference in ethmoid sinus volume, in FER and OMC diameters between NSD classification groups. In the contralateral side, FER and OMC diameters were found to be significantly different between group 1 and group 2 and between group 1 and group 3, respectively (P = 0.04 and 0.06, respectively). Both the presence and severity of the NSD did not statistically significant influence the pneumatization of variant structures, air cells and vital structures.

CONCLUSION

The severity of NSD effects the ethmoid sinus volume. The relationship of FER and OMC with NSD is evident, however this may not always be in a proportional pattern. The paranasal pneumatization did not affect Keros type, bone integrity of carotid canal and optic canal.

An Analysis of Association Between Nasal Bone Morphology and Sinonasal Anatomical Variations

The goal of this study was to investigate the association between various sinonasal anatomical variations and the morphological features of lateral nasal bone, using paranasal computerized tomography (PNCT) sections. Two hundred and fifty patients who underwent a PNCT scan because of a prediagnosis of nasal septum deviation or sinusitis were included in the study. For each patient, presence of the following anatomical variations was determined on CT sections: length and thickness of nasal bone, thickness of intermediate nasal bone, pneumatized middle turbinate, paradox middle turbinate, Agger nasi cell, Haller cell, Onodi cell, supraorbital cell, pneumatized uncinate process, and nasal septal deviation. The effect of each anatomical variation on the length and thickness of the lateral nasal bone was investigated. The patients with bilateral pneumatized middle turbinate and the patients with bilateral Agger nasi cell had a thinner lateral nasal bone both on the right and the left sides compared to those without. The patients with bilateral Onodi cell and Agger nasi cell had a longer lateral nasal bone both on the right and the left sides compared to those without. The nasal bone thickness was significantly thicker on the deviation side than the contralateral nasal bone. The nasal bone length was significantly longer on the side of the septum deviation. In this study, we found that sex, presence of Agger nasi and Onodi cells, pneumatization of middle turbinate, and direction of nasal septal deviation influenced the morphology of the nasal bone. For successful nasal surgery, careful examination of preoperative anatomical variations is very important.

Morphometric Analysis of Sphenoid Sinus in Patients With Nasal Septum Deviation

This retrospective study aimed to assess the association of the volume and types of the sphenoid sinus with deviated nasal septum by analyzing multislice computed tomography images. A total of 93 patients with a deviated nasal septum and 70 healthy controls were included in the study. Patients with sinonasal morbidities other than deviation were excluded. Three-dimensionally reconstructed computed tomography images of the study participants were acquired. A total of 326 sphenoid sinus volumes from the patient and control groups were obtained and compared between the groups. Sphenoid sinus volumes and the angle of the deviation were measured for standardization and assessment of the severity. Deviated nasal septum was found on the right in 49.5% (n = 46) and on the left in 50.5% (n = 47) of the study participants. Deviation angles were in the range from 7.2° to 22.4° and the mean value was 13.2° ± 5.0°. The measured volumes were in the range from 1.8 cm to 9.6 cm with a mean of 4.8 ± 1.5 cm. In the control group, the median values for the sphenoid sinus volumes were 4.40 cm (0.80-8.90 cm) on the right and 4.20 cm (0.90-8.70 cm) on the left. In the study group, sphenoid sinus volumes were found to be statistically significantly different between those on the ipsilateral and contralateral side of the septal deviation. Sphenoid sinus volumes were significantly smaller on the same side with septal deviation compared with those on the contralateral side. There was no statistical relationship between the presence of septal deviation, age and gender, and the type of sphenoid sinus.

One-Piece Nasal Osteotomy for the Correction of a Centrally Deviated Nose

BACKGROUND

A severely crooked nose due to trauma or other causes is difficult to correct. Although various nasal osteotomy techniques have been suggested, satisfactory outcomes have not always been achieved especially in centrally deviated noses. Definite correction of the midline and shape of the bony framework is necessary. We aimed to investigate a novel one-piece nasal bone osteotomy approach consisting of transverse osteotomy continued with bilateral lateral osteotomies for the correction of a centrally deviated nose.

METHODS

This retrospective chart review included 66 consecutive patients who underwent corrective rhinoplasty with nasal bone osteotomy for a deviated nose. Group 1 was treated with one-piece osteotomy, and group 2 was treated with conventional lateral and/or medial osteotomy. Available preoperative and postoperative three-dimensional facial bone computed tomography images were used to quantify nasal landmarks through three-dimensional reconstruction. Patient satisfaction was evaluated using a rhinoplasty outcome evaluation questionnaire.

RESULTS

Measurements of nasal landmark angles toward the longitudinal facial midline plane showed a statistically narrowed postoperative angle in group 1 (subnasale landmark: preoperative angle 1.66 ± 0.29° [group 1] vs. 0.76 ± 1.09° [group 2]; postoperative angle 0.96 ± 0.77° [group 1] vs. 0.31 ± 0.29° [group 2]). The questionnaire scores revealed higher satisfaction (3.11 ± 2.38 vs. 1.157 ± 1.147) and a higher proportion of 4-point scores in group 1.

CONCLUSIONS

This is the first study to introduce the one-piece nasal osteotomy technique for centrally deviated noses. The technique consists of transverse osteotomy with bilateral osteotomies in one stage, thus the name "one-piece." Considering anatomic variances in Asian rhinoplasty, a deviated nose should be effectively corrected to obtain satisfactory outcomes. We demonstrated the efficacy and satisfactory outcomes of this new technique.

LEVEL OF EVIDENCE IV

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Evaluation of the Characteristics and Association Between Schneiderian Membrane Thickness and Nasal Septum Deviation

OBJECTIVE

Nasal septum deviation (NSD) is an anomaly that disturbs normal mucus drainage in sinuses, leading to recurrent sinusitis. Sinusitis, infections, and mucosal irritations are the potential causes of Schneiderian membrane thickening (SMT). The aim of this study was to evaluate the characteristics and association between NSD and SMT along with factors such as age, gender, and tooth groups using cone-beam computed tomography (CBCT) imaging.

METHODS

The maxillary sinus and nasal cavity of 249 patients (136 females and 113 males) were examined retrospectively using CBCT. The statistical analysis was performed to determine the association between SMT, NSD, gender, and age.

RESULTS

No statistically significant relation was detected between NSD and SMT. The NSD was found in 50.6% of patients without gender predilection. Age was not associated with the presence of NSD. The mean thickness of the membrane was least in the third molar region and highest in the first molar region. The average SMT was found to be higher in males for all the examined tooth areas (P ≤ 0.05).

CONCLUSION

A retrospective evaluation of CBCT images emphasized the concept that NSD was not a factor that affected the thickening of maxillary sinus mucosa. The CBCT imaging could be used for evaluating the maxillary sinuses and nasal septum.

Effect of Deviated Nasal Septum on Maxillary Sinus Volume and Occurrence of Sinusitis

Nose is the central part of mid-face and has an important functional, aesthetic and psychological role. The first modern and accurate descriptions of the paranasal sinuses can be traced to the works of the late 19th century Austrian anatomist Emil Zuckerkandl. In our study we tried to relate deviated nasal septum (DNS) with occurrence of sinusitis and its effect on volume of the maxillary sinus. It is a pioneer study in the field of otolaryngology and not many studies have been conducted on this topic. This is a cross sectional study involving patients with deviated nasal septum and having symptoms of sinusitis like fever, general malaise, body ache, headache, pain, tenderness, nasal discharge and post nasal discharge. The study was conducted at the department of otolaryngology at a tertiary care center on 84 subjects out of which 71 patients got CT scan done, which were included in the study. All subjects having Grade 5 and 6 DNS showed blocked osteomeatal complex (OMC) on CT scan while in Grade 2 the occurrence was only 50%. This finding was suggestive of increase in incidence of OMC block with increasing grade of DNS. The maxillary sinus volume for the cases was seen maximum in range of 9.1-10 cu mm by software and in the range of 8.1-9 cu mm for geometric analysis. Cases with Grade 2 DNS showed maximum cases in volume range of 11.1-12 followed by 9.1-10. On the other hand volume by geometric analysis showed equal cases in range 8.1-9 and 10.1-11. The study showed strong association of blocked OMC with high grade DNS. It also showed reduced sinus volume in higher grades of DNS. Further studies are needed in this field with a higher number of subjects to establish the relation between decreased volume of maxillary sinus and grade of DNS.

Paranasal Sinus Anatomic Variations Accompanying Maxillary Sinus Retention Cysts: A Radiological Analysis

Objective

The risk factors for the development of retention cysts of the maxillary sinuses (RCMs) are not clear, although RCMs are common findings on radiographic images. This study was conducted to evaluate the correlation between RCMs and other nasal-paranasal anomalies and to demonstrate the possible effects of these anomalies on the development of RCMs.

Methods

In the study, paranasal sinus computerized tomography (PNsCT) images from 5166 patients were retrospectively reviewed. Correlations between RCMs and osteomeatal complex obstruction, accessory ostium presence, abnormalities of the middle turbinate, and nasal septal deviation were analyzed in the PNsCT images. The paranasal sinus anomalies on the side of the RCMs were compared to the contralateral side.

Results

A total of 1880 RCMs were detected in 1429 (27.6%) of 5166 patients. At least one nasal-paranasal sinus anomaly was associated with 88.7% of the RCMs. In the descending order, accessory ostium presence, accessory ostium, middle turbinate anomalies, and nasal septal deviation are pathologies that accompany RCMs. When unilateral RCMs were compared with the normal side, significant correlations were observed between RCMs and osteomeatal complex obstruction, accessory ostium, and middle turbinate anomalies (p=0.001, p=0.016, and p=0.03, respectively). RCMs were commonly found on the same side as osteomeatal complex obstruction (p=0.001), middle turbinate anomalies (p=0.001), and accessory ostium (p=0.052).

Conclusions

In this study, the coexistence of osteomeatal complex obstruction, accessory ostium, middle turbinate anomalies, and nasal septum deviation with RCMs was analyzed by investigating PNsCT findings in 5166 patients. The results show that RCMs are associated with pathologies that increase paranasal inflammation, such as osteomeatal complex obstruction, and are good markers for nasal-paranasal sinus anomalies. The presence of incidental RCMs should be a warning sign of nasal-paranasal sinus anomalies.

Evaluation of Patient Satisfaction After Nasal Septoplasty Operation Using Peak Nasal Inspratuar Flow and Nasal Obstruction Symptom Score Questionare

BACKGROUND

The purpose of this study was to investigate the usefulness of the peak nasal inflamatuar flow (PNIF) and Nasal Obstruction Symptom Score (NOSE) questionnaire in the diagnosis and follow-up of nasal septum deviation surgery.

METHODS

Sixty patients diagnosed with nasal septum deviation were included in the study. Nasal Obstruction Symptom Score scales of patients, PNIF and is measured preoperatively and 14 days after surgery.

RESULTS

Preoperative NOSE scores were 14.9 ± 2.7 and PNIF scores were 129.6 ± 15.5 L/min in study group. Postoperatively NOSE scores were 7.9 ± 1.8 and PNIF scores were 154.2 ± 9.2 L/min in study group. Nasal Obstruction Symptom Score scores were 3.3 ± 2.3 and PNIF scores were 169.3 ± 13.5 L/min in control group.

CONCLUSION

Anterior and anteroposteriorly located nasal septum deviation (NSD) had statistically higher degrees of NOSE scores and lower levels of PNIF scores. Posterior located NSD PNIF scores changed postoperatively but NOSE scores do not change statistically. There was a statistically significant correlation in Pearson correlation analysis between NOSE and PNIF scores. The authors recommend using PNIF and NOSE scores in NSD patients.

Relationship between the degree and direction of nasal septum deviation and nasal bone morphology

BACKGROUND

Nasal septal deviation may affect nasal bone growth and facial morphology. Knowledge of nasal morphologic parameters may plays an important role in planning successful rhinoplasty and septoplasty operation. The aim of our study was to evaluate the relationship between the direction and degree of nasal septal deviation with nasal bone morphology, along with factors such as age and gender.

METHODS

Maxillofacial computed tomography (CT) of 250 patients with nasal septal deviation was analyzed retrospectively in this study. We excluded patients with factors that could affect their nasal bone morphology, and a total of 203 patients (111 males, 92 females; mean age, 36.23 years; age range, 18-79 years) were evaluated. The nasal deviation angle was measured on coronal CT images as the angle between the most deviated point of the septum, and the midline nasal morphology was determined by measuring nasal length, internasal angle and lateral and intermediate nasal thickness on both sides.

RESULTS

The deviation of nasal septum has been detected as to the right in 107 patients (52.7%) and to the left in 96 patients (47.3%). Lateral and intermediate nasal bone thickness and nasal bone length were significantly greater on the ipsilateral deviation side (Table 3). No significant correlation was found between the variation of the nasal deviation angle and nasal bone morphology (Table 4). There were significant differences between the sexes for all investigated parameters except for the nasal deviation angle (p = 0.660). We found that the only internasal angle increases with aging (p = 0.002).

CONCLUSION

The study shows that the direction of nasal septal deviation may be a factor that affects nasal bone morphology.

Risk Factors and Comorbidities in Chronic Rhinosinusitis

Chronic rhinosinusitis (CRS) is a heterogeneous disorder that creates a significant burden on the healthcare system. It is caused by a combination of inflammatory, environmental, and host factors; however, the precise mechanism of how each factor leads to CRS continues to be a source of debate. Previous data regarding this topic is often inconsistent or of lower quality. In this article, we review the recent literature on the risk factors and comorbidities in CRS. Large population-based studies have helped establish smoking as a significant risk factor for CRS. The focus has now shifted towards smoking and its effect on long-term outcomes after endoscopic sinus surgery (ESS). Ciliary dyskinesia, both primary and secondary, can affect both the sinonasal cavity and lower airways simultaneously by decreasing the beat frequency of cilia and inducing mucostasis. The effects of secondary dyskinesia may be reversible and there is some evidence to suggest the use of topical mucolytics in patients with CRS. Allergy and variants of sinonasal anatomy have been hypothesized to increase the risk of developing CRS by inducing chronic inflammation and obstructing the sinus ostia. Nevertheless, emerging data regarding these topics continue to produce inconclusive results. Inflammation of the upper and lower airways can occur simultaneously as seen in patients with asthma and aspirin sensitivity. The connection between these pro-inflammatory disease states has been known for many years. Newer evidence include large population-based studies and studies that correlate objective tests, such as computer tomography scans to pulmonary function tests. However, the treatment of CRS and its effects on obstructive airway disease continues to be a topic of debate. More large prospective studies are needed in order to continue refining our knowledge of the disease processes in CRS.

Is there a relationship between sphenoid sinus types, septation and symmetry; and septal deviation?

In the present study, we investigated whether there is a relationship between sphenoid sinus (SS) types, septation (lobulation) and symmetry; and septal deviation (SD) by multidetector computed tomography (MDCT). Paranasal MDCT images of 202 subjects (131 males, 71 females), between 10- and 88-year-old, were included into the study. SS type (conchal, presellar or sellar), SS symmetry, SS septation (lobulation) and SD were evaluated by MDCT images. In the present study, in both males (83.2 %) and females (85.9 %); and in all age groups (80.4-85.7 %), sellar type sphenoid sinus were more detected. Conchal type was detected in two cases of the males (1.5 %) and none of the females. SS was detected mainly as multi-septated (multi-lobulated) (51.9 % in males and 56.3 % in females; in all age groups as 51.0-56.8 %; and both SD (+) and SD (-) groups as 51.2-56.8 %). In subjects with SD, asymmetric SS was detected in 80.2 %. Whereas in SD (-) subjects, asymmetric SS was detected in 50.6 %. Sellar type SS pneumatization is the most detected type in our cases. Presence of SD was related to the higher SS asymmetry values. In SD (-) subjects, SS was detected as symmetric. Nasal septal deformities such as SD may influence the development of the SS pneumatization and asymmetric septation. For well anatomic orientation of the surgeons, good anatomy knowledge and preoperative detailed examination of the CT scans are very important.

The pterygopalatine recess of the superior nasal meatus

The pneumatizations surrounding the pterygopalatine fossa (PPF) and closely related to the sphenopalatine foramen are anatomically variable. During the assessment of a cone beam computed tomography of a 64-year-old male patient, we found bilaterally a previously unreported anatomic variant. This was represented by a lateral or pterygopalatine recess (PPR) of the superior nasal meatus which extended in the anterior wall of the PPF and protruded within the maxillary sinus to determine a maxillary bulla. The PPR was antero-superior to the sphenopalatine foramen. Additionally were found a right nasal septal deviation, seemingly compensated by a left middle concha bullosa and a left prominent ethmoidal bulla. The superior turbinates were also pneumatized. Such anatomic variants related to the pterygopalatine angle of the maxillary sinus should be explored prior to surgical or endoscopic procedures which target the maxillary sinus, the pterygopalatine fossa, or the skull base.