Abstract
Objective. To systematically review the international literature for internal nasal septal deviation classification systems and summarize them for clinical and research purposes. Data Sources. Four databases (including PubMed/MEDLINE) were systematically searched through December 16, 2015. Methods. Systematic review, adhering to PRISMA. Results. After removal of duplicates, this study screened 952 articles for relevance. A final comprehensive review of 50 articles identified that 15 of these articles met the eligibility criteria. The classification systems defined in these articles included C-shaped, S-shaped, reverse C-shaped, and reverse S-shaped descriptions of the septal deviation in both the cephalocaudal and anteroposterior dimensions. Additional studies reported use of computed tomography and categorized deviation based on predefined locations. Three studies graded the severity of septal deviations based on the amount of deflection. The systems defined in the literature also included an evaluation of nasal septal spurs and perforations. Conclusion. This systematic review ascertained that the majority of the currently published classification systems for internal nasal septal deviations can be summarized by C-shaped or reverse C-shaped, as well as S-shaped or reverse S-shaped deviations in the anteroposterior and cephalocaudal dimensions. For imaging studies, predefined points have been defined along the septum. Common terminology can facilitate future research.
Highlights
Nasal septal deviations play a critical role in nasal obstruction symptoms, aesthetic appearance of the nose, increased nasal resistance, and sometimes snoring [1]
The importance of a summary is notable when studies report the prevalence of nasal septal deviations, given that studies reporting findings by using a handheld otoscope will have a lower prevalence of nasal septal deviations than those that use endoscopy or computed tomography because the handheld otoscope
Of the 50 articles reviewed in their entirety, the following are reasons for exclusion: two were letters to the editor [13, 49], one classified nasal defects based on subunits and corrective surgeries [24], one study correlated previously described systems in their patients [37], one used a previously published classification system [46], one described trauma and surgical techniques [2], two referenced their own previously described classification system [21, 28], one was a questions and answers article [17], two articles focused on the external nasal deformities [15, 39], fourteen articles focused on operative techniques [4, 18,19,20, 29,30,31,32, 35, 36, 38, 40, 47, 50], and ten articles failed to meet criteria as classification systems [5, 7, 9,10,11,12, 14, 22, 34, 42]
Summary
Nasal septal deviations play a critical role in nasal obstruction symptoms, aesthetic appearance of the nose, increased nasal resistance, and sometimes snoring [1]. Individual authors and groups studied the assessment and classification of internal nasal septal deviations but none to date conducted a systematic evaluation of these studies with a comprehensive summarization of the individual results. Because of the variation in classification systems, such as grading internal septal deflections in the anterior aspect versus along the entire nasal airway, utilizing physical examination versus computed tomography, a summary of the currently published international literature would help facilitate future research. The importance of a summary is notable when studies report the prevalence of nasal septal deviations, given that studies reporting findings by using a handheld otoscope will have a lower prevalence of nasal septal deviations than those that use endoscopy or computed tomography because the handheld otoscope
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