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Gupta KK, Davda D, Mughal Z, Lotfallah A, Anari S. Correlation of maximal nasal septal deviation with deviation at the maxillary insertion. Surg Radiol Anat 2024; 46:567-573. [PMID: 38489066 DOI: 10.1007/s00276-024-03334-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 02/23/2024] [Indexed: 03/17/2024]
Abstract
PURPOSE It is unclear if septal deviation at the insertion points to the nasal cavity is associated with the overall septal deviation. This study aimed to assess septal deviation at the cribriform plate (CP) and maxillary crest (MC) using CT scans and to see if there was any correlation with overall septal deviation. METHODS All consecutive CT sinus scans between January 2020 and December 2021 were retrospectively reviewed. Patients were excluded if they had a history of head, nasal or facial trauma, or any previous nasal surgical procedure. Angles between the septum and MC and the septum and CP as well as maximal angle of septal deviation (MSD) were measured. RESULTS A total of 70 scans were included in the final analysis. The mean MSD was 8.14°. The mean septal deviation was 0.89° at the CP and 2.02° at the MC. The correlation coefficient between the deviation at the CP and MSD was 0.025 and between the deviation at the MC and MSD was 0.321. CONCLUSION Our data reveal a positive correlation between septal deviation at the floor of the nose and overall septal deviation; this was not observed at the septal deviation at the roof. This could be explained due to the inherent tilt in the cribriform plate or by earlier ossification and fixation of the septum during its development at its insertion to the roof, thereby allowing further growth and potential for deviation of the lower part of the septum and its insertion to the floor.
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Affiliation(s)
- Keshav Kumar Gupta
- Department of Otorhinolaryngology Heartlands Hospital, University Hospitals Birmingham NHS Trust, Bordesley Green East, Birmingham, B9 5SS, England.
| | - Dean Davda
- Department of Radiology Heartlands Hospital, University Hospitals Birmingham NHS Trust, Birmingham, England
| | - Zahir Mughal
- Department of Otorhinolaryngology Queen Elizabeth Hospital, University Hospitals Birmingham NHS Trust, Birmingham, B15 2TH, England
| | - Andrew Lotfallah
- Department of Otorhinolaryngology Queen Elizabeth Hospital, University Hospitals Birmingham NHS Trust, Birmingham, B15 2TH, England
| | - Shahram Anari
- Department of Otorhinolaryngology Heartlands Hospital, University Hospitals Birmingham NHS Trust, Bordesley Green East, Birmingham, B9 5SS, England
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Heppt H, Widmann G, Riechelmann F, Runge A, Riechelmann H, Giotakis AI. CT comparison of the nasal airway anterior and posterior to the piriform aperture in patients with and without nasal obstruction. Head Face Med 2024; 20:20. [PMID: 38532483 DOI: 10.1186/s13005-024-00420-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/10/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Nasal airway stenosis may lie anterior and/or posterior to the piriform aperture. We intended to compare the nasal airway anterior and posterior to the piriform aperture in patients with and without nasal obstruction. METHODS Segmented computed tomography cross-sectional areas of the nasal airway anterior (CT-CSAant) and posterior to the piriform aperture (at the level of the head of the inferior turbinate; CT-CSApost) were compared between patients with nasal obstruction (cases) and trauma controls. CT-CSA were approximately perpendicular to the direction of the nasal airflow. Anterior to the piriform aperture, they were tilted about 30o, 60o and 90o to the nasal floor. Posterior to the piriform aperture, they were tilted about 50o, 80o and 100o to the nasal floor. In cases, we examined the Pearson's correlation of active anterior rhinomanometry with CT-CSAant and CT-CSApost. RESULTS Narrow and bilateral CT-CSApost were similarly large between 56 cases and 56 controls (all p > 0.2). On the contrary, narrow and bilateral CT-CSAant were significantly smaller in cases than in controls (all p < 0.001). The ratio of the size of CT-CSAant-30 to that of CT-CSApost-80 was significantly lower in cases (median: 0.84; lower to upper quartile: 0.55-1.13) than in controls (1.0; 0.88-1.16; Mann-Whitney U test; p = 0.006). Bilateral CT-CSAant correlated significantly with total inspiratory flow (all p < 0.026) in contrast to bilateral CT-CSApost (all p > 0.056). CONCLUSIONS The nasal airway anterior to the piriform aperture was smaller in patients with nasal obstruction due to skeletal nasal stenosis than that in controls. On the contrary, the nasal airway posterior to the piriform aperture was similarly large between patients with and without nasal obstruction. Furthermore, in patients with nasal obstruction, the anterior nasal airway was narrower compared to that located posterior to it. On the contrary, control patients' anterior nasal airway was as large as the posterior one.
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Affiliation(s)
- Helen Heppt
- Department of Otorhinolaryngology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, 6020, +435050423141, Austria
| | - Gerlig Widmann
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Felix Riechelmann
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Annette Runge
- Department of Otorhinolaryngology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, 6020, +435050423141, Austria
| | - Herbert Riechelmann
- Department of Otorhinolaryngology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, 6020, +435050423141, Austria
| | - Aris I Giotakis
- Department of Otorhinolaryngology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, 6020, +435050423141, Austria.
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Kapıcı OB, Abuş S, Ayhan S, Koparal M, Kaya H. Comparison of frontal QRS-T angle of patients with nasal septal deviation with healthy controls. BMC Cardiovasc Disord 2023; 23:415. [PMID: 37612611 PMCID: PMC10464060 DOI: 10.1186/s12872-023-03421-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 07/30/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND This study compares frontal QRS-T angle (fQRS-T) in electrocardiogram (ECG) examinations of people with nasal septal deviation (NSD) with healthy controls (HC). METHODS Eighty-two patients whom a radiologist with paranasal computed tomography definitively diagnosed with NSD were included in the study. 101 individuals without NSD were selected as HC. RESULTS Compared to the HC group, the fQRS-T in was considerably wider in patients with NSD (p < .001). According to Spearman correlation analysis, fQRS-T and NSD angle, and platelet lymphocyte ratio (PLR) were significantly correlated (p = .021, p < .001, and p = .003, respectively). In linear regression analysis where the fQRS-T was taken as a dependent variable, NSD angle and PLR predicted the fQRS-T significantly and positively (F(5.76) = 8.451, R2 = 0.357, Adjusted R2 = 0.315 and p < .001). CONCLUSION In this study, fQRS-T was significantly higher in patients with NSD. In future studies, fQRS-T can be compared before and after septoplasty in NSD patients.
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Affiliation(s)
- Olga Bayar Kapıcı
- Department of Radiology, Adiyaman University Education and Research Hospital, Adiyaman, Turkey.
| | - Sabri Abuş
- Department of Cardiology, Adiyaman University Education and Research Hospital, Adiyaman, Turkey
| | - Selçuk Ayhan
- Department of Cardiology, Adiyaman University Education and Research Hospital, Adiyaman, Turkey
| | - Mehtap Koparal
- Department of Otorhinolaryngology, Adiyaman University Education and Research Hospital, Adiyaman, Turkey
| | - Hakan Kaya
- Department of Cardiology, Adiyaman University Education and Research Hospital, Adiyaman, Turkey
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Martins de Sousa M, Rebelo J, Martins S, Silveira H, Órfão T, Pinto Moura C. Is Computed Tomography Necessary Before Septoplasty? Correlation With Physical Examination and Patient Complaints. Cureus 2023; 15:e38558. [PMID: 37273365 PMCID: PMC10239293 DOI: 10.7759/cureus.38558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2023] [Indexed: 06/06/2023] Open
Abstract
INTRODUCTION Septoplasty is one of the most common surgeries performed by otorhinolaryngologists. The gold standard for the evaluation of septal deviation is anterior rhinoscopy and nasal endoscopy. Frequently, computed tomography (CT) is also performed, although the correlation between septal deviation on CT and physical examination is unclear. OBJECTIVES To study the relationship between symptoms and physical and radiological evaluation in patients who underwent septoplasty. METHODS A prospective study of patients with nasal obstruction and septal deviation who underwent septoplasty. Anterior rhinoscopy and nasal endoscopy were performed by the surgeon, and the CT was evaluated by a radiologist. The degree of obstruction was evaluated in three distinct septal locations. The Nasal Obstruction Symptom Evaluation (NOSE) score was used before the surgery and two months after the surgery. RESULTS The study included 43 patients, of whom 60.5% were male, with an average age of 37.09 years (±12.56). The degree of septal deviation in the physical examination was significantly different from that observed in CT (p˂0.05). Cartilaginous or maxillary crest septal deviations >75% were more commonly recognized by physical examination, while osseous septum deviations of 25%-50% were more easily detected by CT. There was no difference between the degree of septal deviation and the preoperative NOSE. The median preoperative NOSE was 60, and the postoperative was 5, with significant improvement (p<0.05). CONCLUSION CT doesn't appear to be useful in the evaluation of septal deviation since it is different from the findings of a physical examination and isn't associated with the NOSE score. Clinical decisions should be based on a physical examination and patient complaints.
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Affiliation(s)
| | - João Rebelo
- Radiology, Centro Hospitalar Universitário São João, Porto, PRT
| | - Sónia Martins
- Otolaryngology, Centro Hospitalar Universitário São João, Porto, PRT
| | - Helena Silveira
- Otolarhinoryngology, Centro Hospitalar Universitário São João, Porto, PRT
| | - Tiago Órfão
- Otorhinolaryngology, Centro Hospitalar Universitário São João, Porto, PRT
| | - Carla Pinto Moura
- Otorhinolaryngology, Centro Hospitalar Universitário São João, Porto, PRT
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Muacevic A, Adler JR. Relationship Between Nasal Septal Deviation Angles and Turbinates: A Computed Tomography Study. Cureus 2023; 15:e35253. [PMID: 36825074 PMCID: PMC9942431 DOI: 10.7759/cureus.35253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
Background This study aimed to evaluate inferior turbinate hypertrophy caused by nasal septum deviation, nasal septal deviation (SD) angles, and age differences with the help of paranasal computed tomography (CT) and to investigate the relationship between these parameters. Methodology The paranasal sinus CT images of 100 patients (50 males and 50 females) were retrieved from the hospital's picture archiving and communication system. In this retrospective study, patients were examined in two groups. There were 50 patients aged >35 years in group 1 and 50 patients aged <35 years in group 2. The SD side was determined using a coronal image and was mentioned as the ipsilateral side. The contralateral side of the SD side was mentioned as the contralateral side. Additionally, the SD curve angle (SDCA), superior SD angle (SSDA), and diameters and mucosal thicknesses of the inferior turbinates were measured. Concomitant ipsilateral sinusitis and ipsilateral concha bullosa (in the middle concha) were also noted as present or absent. Results In our study, the SDCA values of the ≥35-year age group were significantly higher than those of the <35-year age group (p < 0.05). Furthermore, the SSDA values of the ≥35-year age group were significantly lower than those of the <35-year age group (p < 0.05). In each of the age groups, ipsilateral inferior turbinate mucosal thickness and ipsilateral inferior turbinate diameter values were significantly higher than those of the contralateral sides (p < 0.05). Ipsilateral concha bullosa was present in 30.0% of the <35-year age group and 18.0% of the ≥35-year age group. Ipsilateral sinusitis was present in 34.0% of the <35-year age group and 52.0% of the ≥35-year age group. Conclusions SD and inferior turbinate hypertrophies should be evaluated together and measured with paranasal CT to provide more efficient nasal aeration. Studies with larger patient series are needed to elucidate the etiology.
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Kumar M, Panneerselvam E, Prabhu K, Ganesh SK, Vb KKR. Prospective cohort study on short-term evaluation of septoplasty as early management of naso-septal fractures - A correlation of clinical outcomes with computational fluid dynamic parameters. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:639-644. [PMID: 35853555 DOI: 10.1016/j.jormas.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 06/12/2022] [Accepted: 07/15/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Post-traumatic deviated nasal septum (PTDNS) leads to impaired breathing and poor esthetics. The aim of this study was to assess treatment outcomes of early septoplasty for correction of PTDNS and correlate it with computational fluid dynamic (CFD) parameters. METHODS This prospective cohort study included patients who underwent early septoplasty for PTDNS. Outcome variables were clinical (pain, nasal symmetry, and nasal obstruction) and computational (velocity, pressure, wall shear stress and Reynold's number). The cohort consisted of two groups: patients with history of closed reduction for nasal fractures (CR) and patients without (NCR). The primary outcome measure was response to treatment. Correlation between clinical and computational parameters, and influence of closed reduction on septoplasty outcomes were the secondary and tertiary outcomes, respectively. Descriptive and inferential statistics were performed to analyze data. Level of significance was fixed at 5% (α = 0.05). RESULTS The sample included 12 patients, of which 5 underwent CFD analysis. Pain score reduced from a pre-operative mean of 7.3 to 0.5 post-operatively (p<0.001). All patients demonstrated reduction of nasal obstruction (p<0.001) and deviation (p<0.001) post-operatively. CFD analysis revealed post-operative reduction of velocity (p = 0.005) and Reynold's number (p = 0.007), with positive correlation between nasal obstruction and CFD parameters. Though patients in the CR group demonstrated reduced nasal deviation and obstruction before septoplasty, as compared to the NCR group, their outcomes were comparable following septoplasty. CONCLUSION Early septoplasty improves functional and esthetic outcomes in patients with PTDNS. CFD simulation is a predictable method to objectively evaluate nasal function.
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Affiliation(s)
- Muthu Kumar
- Department of Oral & Maxillofacial Surgery, SRM Dental College & Hospital, Ramapuram Campus, Ramapuram, Chennai, India
| | - Elavenil Panneerselvam
- Department of Oral & Maxillofacial Surgery, SRM Dental College & Hospital, Ramapuram Campus, Ramapuram, Chennai, India.
| | - Komagan Prabhu
- Department of Oral & Maxillofacial Surgery, SRM Dental College & Hospital, Ramapuram Campus, Ramapuram, Chennai, India
| | - Sriraam Kasi Ganesh
- Department of Oral & Maxillofacial Surgery, SRM Dental College & Hospital, Ramapuram Campus, Ramapuram, Chennai, India
| | - Krishna Kumar Raja Vb
- Department of Oral & Maxillofacial Surgery, SRM Dental College & Hospital, Ramapuram Campus, Ramapuram, Chennai, India
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Comparison of the Type and Severity of Nasal Septal Deviation between Chronic Rhinosinusitis Patients Undergoing Functional Endoscopic Sinus Surgery and Controls. Int J Dent 2022; 2022:2925279. [PMID: 35510085 PMCID: PMC9061061 DOI: 10.1155/2022/2925279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 01/11/2022] [Accepted: 04/06/2022] [Indexed: 11/30/2022] Open
Abstract
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.
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Sari N, Cankal F, Uysal E. Are preoperative CT parameters predictive for the outcome of septoplasty? Niger J Clin Pract 2022; 25:531-540. [PMID: 35439915 DOI: 10.4103/njcp.njcp_1842_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Despite successful septoplasty surgery, some patients still complain of nasal obstruction (NO). Aim Our aim in the present study is to determine whether preoperative computed tomographic (CT) parameters have prognostic significance for the success of septoplasty. Material and Methods Retrospective data from 61 patients in a secondary care hospital who had undergone septoplasty met the inclusion and exclusion criteria. The effects of demographic and preoperative CT parameters (internal nasal valve [INV], external nasal valve area, angle of septal deviation, choana area, aperture pyriformis area, high septal deviation [HSD], transverse diameter of midnose, anterior/posterior deviation, concha and meatus diameter [superior, middle, inferior]) were studied in relation to the change in NOSE scores and the success of surgery. Results Of the 61 patients studied, 31 were male (51%) aged 18-55 years with a mean age ± SD (26.59 ± 9.41). It was found that the changes in NOSE scores were significantly different from each other (P < 0.01). Male gender, trauma history, moderate septal deviation, HSD, mucosal pathology, posterior deviation, bullous turbinate (right and left middle, right superior), and in the absence of allergy, paradoxical turbinate (right and left middle and superior), S-shaped deviation were found to have a significant correlation in the change of NOSE scores (P < 0.05). Age and internal valve differed with respect to outcome (P < 0.05). Variables in multiple linear regresion models of all parameters were found to be insignificant (P < 0.05). Conclusion Preoperative CT parameters are informative, but do not predict the postoperative success of septoplasty.
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Affiliation(s)
- N Sari
- Mardin Otolaryngology Clinic, Mardin Training and Research Hospital, Mardin, Turkey
| | - F Cankal
- Ankara Medipol University, Visart Medical Imaging Center, Ankara, Turkey
| | - E Uysal
- Department of Technique, Vocational School of Technical Sciences, Dicle University, Diyarbakir, Turkey
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Liu JF, Yan ZF, Zhang ZJ, Wang NY. Septoplasty alone is not suitable for most structural nasal obstructions. World J Otorhinolaryngol Head Neck Surg 2021; 7:322-327. [PMID: 34632347 PMCID: PMC8486691 DOI: 10.1016/j.wjorl.2020.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 05/18/2020] [Accepted: 05/20/2020] [Indexed: 11/30/2022] Open
Abstract
Septoplasty is widely used in the treatment of structural nasal obstructions, and it also has a good effect and a high degree of postoperative satisfaction. However, there a large number of structures demonstrate abnormalities related to structural nasal obstruction, including the external nose, maxilla, nasal cavity and paranasal sinus. Nasal septum deviation is only one signs of structural nasal obstruction and does not represent all possible structural abnormalities of the nasal cavity and its surrounding structure. Septoplasty is only performed to correct deviations of the nasal septum, which in many cases is obviously insufficient in restoring the symmetry of the nasal structure. Therefore, septoplasty alone is not suitable for the treatment of most structural nasal obstructions. Nasal ventilation expansion surgery, which typically covers more abnormal structural correction procedures than septoplasty, should be used when describing the treatment of structural nasal obstruction.
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Affiliation(s)
- Jin-Feng Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Zhan-Feng Yan
- Department of Otorhinolaryngology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Zhi-Jin Zhang
- The Third Clinical Medical School, Capital Medical University, Beijing, 100009, China
| | - Ning-Yu Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
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Liu J, Qian Z, Yan Z, Yang X, Wang N. Asymmetry of inferior turbinate in patients with nasal septum deviation and its significance for nasal ventilation surgery. Eur Arch Otorhinolaryngol 2021; 279:2423-2431. [PMID: 34302496 DOI: 10.1007/s00405-021-07012-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 07/20/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE To investigate the asymmetry of the inferior turbinate (IT) in patients with nasal septum deviation (NSD). METHODS The paranasal sinus computed tomography (CT) of 100 patients with NSD were retrospectively investigated from February 2018 to December 2019. The thickness of IT, IT mucosa and IT bone, the distance between the IT and the midline were measured on both the concave and convex sides, and which correlation with NSD was analyzed. RESULTS The widths of the IT, IT bone and IT medial mucosa on the concave side were larger than those on the convex side (all P < 0.05). The distance from the IT and IT bone to the midline on the concave side was smaller than those on the convex side (P < 0.05, respectively). The degree of NSD had a negative correlation with the widths of the IT and IT bone on the convex side, and the distance between the IT and the midline on the concave side; and a positive correlation with the distance from IT and IT bone to the midline on the convex side, and IT mucosa thickness on the concave side (all P < 0.05). CONCLUSION The asymmetric IT width is mainly caused by both hypertrophies of the IT mucosa on the concave side and atrophy of the IT bone on the convex side. Therefore, during the surgery of nasal ventilation reconstruction, the IT on the convex side are suggested to be protected from intervention. In contrast, it is necessary to lateralize the IT bone and reduce the IT submucosal tissue on the concave side. However, routine excision of the IT bone is not recommended.
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Affiliation(s)
- Jinfeng Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing, 100020, China.
| | - Zhuoming Qian
- Department of Otorhinolaryngology, Beijing Huairou Hospital of University of Chinese Academy of Sciences, Beijing, 101400, China
| | - Zhanfeng Yan
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing, 100020, China.,Department of Otorhinolaryngology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Xuwen Yang
- 7 Medical Students of Long Schooling Class 3, The Third Clinical Medical School, Capital Medical University, Beijing, 100020, China
| | - Ningyu Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing, 100020, China
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