Septal Deviation Research Articles

Characterising Sinonasal Pneumatization in Patients with Nasal Septal Deviation: A CBCT-Based Study

Characterising Sinonasal Pneumatization in Patients with Nasal Septal Deviation: A CBCT-Based Study

Prevalence of concha bullosa in a pediatric population

ObjectiveExisting literature on the prevalence of middle turbinate pneumatization, or concha bullosa (CB), in the pediatric population is limited. CB is an anatomic variant important to identify prior to sinonasal surgery and is often associated with congenital nasal septal deviation (SD). This paper aims to describe the prevalence of CB in the pediatric population on head imaging. MethodsA retrospective chart review was performed for 695 children undergoing CT head for trauma from 2021 to 2022. Nearly equal numbers of males and females were evaluated, with at least 19–20 per year from 0.5 to 18 years. Patients with significant facial fractures, sinusitis, craniofacial syndromes, prior sinus surgery, and sinonasal masses were excluded. Two pediatric neuroradiologists evaluated the CTs. CB was defined as aeration >50 % of the vertical height of the middle turbinate. ResultsIn this study, 384 patients were included. The prevalence of CB was 153 (39.8 %), which was significantly higher in children >4 years (p < 0.0001). Lamellar type CB was the most common, present in 160 out of 768 middle turbinates assessed (20.8 %). SD occurred in 60 (39.2 %) patients with CB and was more commonly contralateral to the CB. ConclusionsThe prevalence of CB in the pediatric population is at the lower range of what is reported in the adult literature. The most common type of CB in patients is lamellar. Similar to previous studies, there is an association between CB and contralateral SD. Finally, there is a positive correlation between the severity of CB and the severity of SD.

Exploring the Relationships Between Clinical Examination Findings, Subjective Reported Symptoms and Objective Nasal Patency Measures in Nasal Obstruction: A Baseline NAIROS Sub-Study Analysis.

The role of objective nasal airflow measures using peak nasal inspiratory flow (PNIF) and rhinospirometry in supporting clinical examination findings when offering patients septoplasty remain undefined. To explore the baseline relationships between clinical examination findings, subjective reported symptoms and objective nasal patency measures in nasal obstruction. This is a sub-study of the NAIROS trial. Participants with nasal obstruction secondary to septal deviation were included in this NAIROS sub-study. The side of septal deviation, enlargement of inferior turbinate (IT), the need for IT reduction if septoplasty was being performed, the area of septum deflecting into the airway and observer rated airway block (ORAB-arbitrarily divided by <50% and >50% blockage) were assessed by clinicians. The subjective score of nasal obstruction was assessed using the Double Ordinal Assessed Subjective Scale (DOASS). Objective nasal patency measures (e.g., nasal partitioning ratio, [NPR] and PNIF) were measured using PNIF and rhinospirometry. The mean NPR for left-sided, both-sided and right-sided septal deviation was -0.35, -0.02 and 0.51, respectively (p < 0.001). There was very weak correlation between the requirement for IT reduction and PNIF change (0.13, p < 0.01). There was no difference in mean PNIF (94 L/min vs. 93 L/min) and mean DOASS (0.33 vs. 0.38) for participants with ORAB rated <50% and >50%. The mean NPR for participants with ORAB >50% was higher than for those with ORAB <50% (0.51 vs. 0.41, p = 0.002). There was strong correlation between the DOASS and NPR (+0.737, p < 0.001). The mean DOASS score for right-sided, both-sided and left-sided septal deviation was 0.32, 0.05 and -0.29, respectively (p < 0.001). This study identified strong relationships between the clinician rated side of septal deflection, the patient reported DOASS and the objective NPR measurements. NPR and the clinician rated degree of airway blockage were concordant.

Septoplasty versus non-surgical management for deviated nasal septum: a systematic review and meta-analysis of randomized controlled trials.

This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to evaluate the efficacy and safety of septoplasty versus non-surgical management for patients experiencing nasal obstruction due to deviated nasal septum (DNS). We conducted a comprehensive search of PubMed, Scopus, Embase, Web of Science, Cochrane Library, Clinicaltrials.gov, ICTRP, and ISRCTN for relevant RCTs. The primary outcomes included the Nasal Obstruction Symptom Evaluation (NOSE) scale, Sino-Nasal Outcome Test (SNOT-22), Peak Nasal Inspiratory Flow (PNIF), surgical complications, and quality of life. Data were synthesized using RevMan 5.4 and STATA 18, with effect estimates presented as mean differences (MD) or risk ratios (RR) with 95% confidence intervals (CI). The study protocol was registered with PROSPERO (ID: CRD42024538373). Our search identified 537 studies, of which 3 RCTs involving 721 participants met the inclusion criteria. The meta-analysis revealed that septoplasty significantly improved NOSE and SNOT-22 scores compared to non-surgical interventions at 6 and 12 months of follow-up, despite no notable differences at 3 months post-treatment. No significant difference was observed regarding nasal flow assessed by PNIF. The rate of complications was low, ranging from 0.31% (revision rate) to 4.12% (bleeding and infection rates). Additionally, our qualitative synthesis showed an improvement in the quality of life at 6 and 12 months in the septoplasty group compared with the non-surgical group. This systematic review and meta-analysis of 721 patients revealed the efficacy of septoplasty, with or without turbinate surgery, in improving nasal obstruction symptoms at 6 and 12 months. Additionally, septoplasty consists of a relatively low rate of complications such as bleeding, infection, and septal perforation. Furthermore, a low revision rate was found. Septoplasty improved the quality of life, especially after 6 and 12 months. However, our findings should be interpreted with caution, and further research is needed to consolidate our results.

Evaluation of the presence of nasal septum deviations in individuals with different skeletal malocclusions

OBJECTIVE: The aim of this study was to evaluate the presence of deviated septum in individuals with different skeletal malocclusions. MATERIALS AND METHOD: The study was performed on cone beam computed tomography images of a total of 159 individuals, 53 in each Class I, Class II, and Class III skeletal malocclusion. Nasal septum deviation was analysed in three groups as mild (type 1; &amp;lt;9°), moderate (type 2; 9-15°), and severe (type3; &amp;gt;15°). In addition, the presence of concha bullosa in different skeletal malocclusions was evaluated. The data were analyzed statistically using the Chi-square test and One-way Analysis of Variance (ANOVA). The relationship betweenskeletal malocclusions and types of deviation was determined using Cramèr’s V analysis. RESULTS: There are statistically significant differences between type 2 and type 3 in individuals with Class I skeletal malocclusion and between type 1 and type 3 in individuals with Class II skeletal malocclusion (p=0.046; p&amp;lt;0.01 respectively). In individuals with Class III skeletal malocclusion, no difference was observed between deviation types. In addition, a weak correlation was found between skeletal malocclusion and deviation types (Cramèr’s V = 0.213). No significant difference was observed between the groups in terms of concha bullosa and deviation side (p=0.215). CONCLUSION: Although a significant difference was observed in terms of deviation type in individuals with Class I and II skeletal malocclusion, a weak correlation was observed between the increase in deviation severity and skeletal malocclusions.

The Application of Mask Region-Based Convolutional Neural Networks in the Detection of Nasal Septal Deviation Using Cone Beam Computed Tomography Images: Proof-of-Concept Study.

Artificial intelligence (AI) models are being increasingly studied for the detection of variations and pathologies in different imaging modalities. Nasal septal deviation (NSD) is an important anatomical structure with clinical implications. However, AI-based radiographic detection of NSD has not yet been studied. This research aimed to develop and evaluate a real-time model that can detect probable NSD using cone beam computed tomography (CBCT) images. Coronal section images were obtained from 204 full-volume CBCT scans. The scans were classified as normal and deviated by 2 maxillofacial radiologists. The images were then used to train and test the AI model. Mask region-based convolutional neural networks (Mask R-CNNs) comprising 3 different backbones-ResNet50, ResNet101, and MobileNet-were used to detect deviated nasal septum in 204 CBCT images. To further improve the detection, an image preprocessing technique (contrast enhancement [CEH]) was added. The best-performing model-CEH-ResNet101-achieved a mean average precision of 0.911, with an area under the curve of 0.921. The performance of the model shows that the model is capable of detecting nasal septal deviation. Future research in this field should focus on additional preprocessing of images and detection of NSD based on multiple planes using 3D images.

The Impact of Scroll Ligament Preservation on Nasal Airway Patency in Rhinoplasty: An Objective Study with Rhinomanometry and Acoustic Rhinometry.

Rhinoplasty is a critical surgical intervention aimed at enhancing nasal form and function. However, traditional approaches often compromise the integrity of nasal scroll ligaments, vital for the functionality of the internal nasal valve, leading to potential postoperative nasal dysfunction. Despite the importance of scroll ligaments in maintaining nasal structure and function, the literature lacks objective, quantifiable evidence of their role. This study sought to objectively compare nasal functionality and anatomy between patients undergoing rhinoplasty with bilateral preservation of scroll ligaments and those with bilateral sacrifice of these ligaments, employing computerized rhinomanometric and acoustic rhinometric measurements as evaluative tools. This retrospective, double-blind study was conducted at Tekirdağ Namık Kemal University's Plastic Reconstructive and Aesthetic Surgery and Ear, Nose, and Throat Clinics. The study population comprised patients who underwent rhinoplasty between May 1, 2018, and October 1, 2019. Patients were rigorously selected based on their medical history, including previous nasal surgeries, aesthetic dissatisfaction, and minimal nasal septum deviation. They were then categorized into two distinct groups: one undergoing rhinoplasty with an emphasis on preserving the scroll ligaments (n = 31) and the other where these ligaments were intentionally sacrificed (n = 30). A comprehensive analysis involving preoperative and six-month postoperative computerized rhinomanometry and acoustic rhinometry measurements was conducted to assess the surgical impact on nasal functionality and structure. The statistical comparison focused on evaluating the changes in air pressure and airflow rates, aiming to delineate the functional outcomes attributable to the differing surgical techniques. Our findings reveal a stark contrast in postoperative nasal functionality between the two groups. In the group with preserved scroll ligaments, there was a significant improvement in postoperative computerized rhinomanometric measurements, indicating enhanced nasal airflow and reduced airway resistance. Conversely, the group with sacrificed scroll ligaments exhibited deteriorated postoperative outcomes, with increased nasal airway resistance and decreased airflow. These differences underscore the pivotal role of scroll ligaments in maintaining nasal airway patency and functionality. The study unequivocally demonstrates that the preservation of scroll ligaments during rhinoplasty significantly benefits nasal airway function, as evidenced by improved postoperative rhinomanometry and acoustic rhinometry measurements. This objective data provide a compelling argument for the functional importance of scroll ligaments, advocating for surgical techniques that prioritize their preservation. By highlighting the positive correlation between ligament preservation and enhanced nasal functionality, this research contributes valuable insights into rhinoplasty practices, suggesting a paradigm shift towards approaches that safeguard nasal structural integrity for optimal functional outcomes. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Investigation of nasal cavity alterations in individuals with neurofibromatosis type 1 using CBCT

ObjectivesThis study aimed to investigate nasal septum deviation (NSD), nasal bone length (NBL), and the morphology of the middle nasal conchae (MNC) and inferior nasal conchae (INC), as well as their correlations. Materials and methodsThe sample included 56 cone-beam computed tomography scans divided into two groups: a study group (SG; individuals with NF1; n = 28) and a control group (CG; individuals without NF1; n = 28). NSD, NBL, MNC, and INC classifications were assessed. MNC images were classified as normal, bullous, paradoxical, secondary, and accessory. INC images were classified as normal, lamellar, compact, combined, and bullous. Intra- and interobserver reliability were evaluated. ResultsSG had a mean NSD of 11.6° (±4.5°) compared with 9.6° (±3.2°) for the CG, showing moderate deviations with no significant difference between groups. SG had a mean NBL of 22.4 mm (±3.4 mm) compared with 22.1 mm (±3.2 mm) for the CG, with a statistically significant difference. Both groups exhibited normal, bullosa, and accessory MNC classifications. SG INC were normal, lamellar, and combined, whereas CG INC were normal and lamellar. There was a weak correlation between NSD and NBL across groups. ConclusionIndividuals with NF1 showed longer NBL. The weak correlation between NSD and NBL suggested multifactorial influences on these variations. These findings advance our understanding of craniofacial development in NF1 and highlight the need for further research into nasal cavity involvement in this complex genetic disorder.

Assessment of the Change in the Nasal Septum and Nasal Profile After Le Fort I With Cone Beam Computed Tomography.

This study aimed to determine the relationship between nasal changes and the amount of advancement, impaction, and downward movement of the maxilla after Le Fort I osteotomy. The study included 48 patients who underwent Le Fort I surgery and had pre- and postoperative cone-beam computed tomography records. Changes in the nasal septum were evaluated by measuring septal deviation angles and volumes. In addition, nasolabial angle and width of nasal and alar base were examined. Groups were determined according to the movement of point A (the deepest point on the curvature of the maxillary alveolar process), using a threshold of 1.5 mm for vertical movements and 4 mm for sagittal movements. This resulted in the comparison of 6 groups of 8 people each. Results are presented as mean and standard deviation or median and range depending on the data distribution. Significance level was accepted as P < 0.05. There were no significant differences for each group on its own septal deviation volume or angle values pre/postoperatively. Groups 3 and 5, which both had at least 1.5 mm of impaction, showed significant changes in both deviation angle and volume between the preoperative and postoperative measurements. Nasolabial angle did not show significant changes between groups. Alar base width and nasal width increase was significantly highest in Group 1, which has more than 4 mm sagittal movement and less than 1.5 mm vertical movement. Le Fort I osteotomy may lead to undesirable changes in the spatial positioning of the nasal septum. The results of this study suggest that maxillary advancement does not significantly impact septal deviation, whereas maxillary impaction increases the amount of deviation. In addition, nasal width and alar base width tended to increase, and the nasolabial angle tended to decrease slightly, regardless of the direction of movement of the maxilla after orthognathic surgery. Surgeons should consider increased nasal septal deviation risks when planning impaction of the maxilla. The soft tissue changes in the nose vary according to different directions and amounts of Le Fort I surgery.

Sphenopalatine ganglion block for pain control after septoplasty: a systematic review and meta-analysis with trial sequential analysis.

Septoplasty corrects a deviated nasal septum (DNS) and improves nasal obstruction. Sphenopalatine ganglion block (SPGB) effectively reduces postoperative pain after septoplasty, but conclusive evidence is still lacking. This systematic review and meta-analysis aim to comprehensively evaluate the analgesic efficacy of SPGB in septoplasty patients. We systematically searched PubMed/Medline, Scopus, Web of Science, Embase, and CENTRAL from inception to April 10th, 2024. Randomized controlled trials (RCTs) were assessed using the RoB-2 tool. The primary outcomes were postoperative pain scores, analgesic consumption, surgery duration, postoperative nausea and vomiting (PONV), and patient satisfaction. Continuous data were pooled as mean difference (MD), and dichotomous data as risk ratio (RR) with a 95% confidence interval (CI) using STATA software. Additionally, trial sequential analysis (TSA) was conducted. Three RCTs with 180 patients were included. Two RCTs had a 'low risk' of bias, while one RCT had 'some concerns'. The SPGB group had significantly lower postoperative pain within 24 hours compared to controls, particularly after particularly after 1-2 hours (MD = -1.85), 4-6 hours (MD = -2.02), 12 hours (MD = -2.14), and 24 hours (MD = -2.36) TSA confirmed the conclusive evidence. Analgesic use was significantly reduced in the SPGB group. No significant differences were observed in surgery duration or PONV rates between groups. Patient satisfaction was significantly higher in the SPGB group. SPGB demonstrates efficacy and safety in managing postoperative pain in patients undergoing septoplasty for DNS.

Fibromyalgia symptoms before and after septoplasty: A cross-sectional study.

This study aimed to investigate the impact of septoplasty on fibromyalgia symptoms in patients with septum deviation. Patients who were over 18 years of age, had been diagnosed with nasal septum deviation, and indicated for septoplasty were selected consecutively and included in the study. Patients were evaluated twice, at baseline and after septoplasty at 3 months. The patients' widespread pain and symptom severity scores were calculated according to the American College of Rheumatology 2016 Revised Fibromyalgia Diagnostic Criteria. A Revised Fibromyalgia Impact Questionnaire was filled out to evaluate the patients' fibromyalgia symptoms. The Pittsburgh Sleep Quality Index was used to assess the sleep quality of patients. Thirty-five patients, 21 (60.0%) male and 14 (40.0%) female, were accepted to the study. Nine (25.9%) patients had fibromyalgia at the beginning, and none of the patients met the fibromyalgia criteria after the surgery. After septoplasty, a statistically significant decrease was detected in the patients' widespread pain index, symptom severity scale, total score, and Pittsburgh Sleep Quality Index and Revised Fibromyalgia Impact Questionnaire scores (P = .006, P = .004, P = .028, P = .014, and P < .001, respectively). As a result of the study, it was observed that fibromyalgia symptoms of patients with septum deviation improved after surgical correction of the deviation.

"Primary anterior septoplasty in a cleft repair improves deviation of the anterior septum but not that of the posterior bone structure."

Evaluation of the result on the nasal septum (NS) of primary anterior septoplasty in cleft surgery is lacking. The deviation in patients with a cleft between those with (S+) and without (S-) primary anterior septoplasty during a cleft lip repair was compared. This was a retrospective, descriptive, single-center study. The NS was evaluated on computed tomography scans obtained pre-operatively from patients who underwent surgery for an alveolar cleft defect. Deviation of the NS was evaluated based on the following parameters: 3D configuration of the NS; anterior, middle, or posterior severity of the NS deviation; location of the most projected point; and severity index. The mean age of evaluation was 6.18 years. A total of 44 (S-) and 48 (S+) patients were included. The NS was less prominent in the (S+) than in (S-) group, 6.25% vs 25%. respectively. In the anterior part, the NS was normal in 79% (S+) and 1% (S-) of the patients. In the posterior region, the prominent deviation rate was approximately 7% in both groups. The greatest deviation point location was identical in both groups. The severity index was higher in the (S-) than in (S+) group, except in the middle part of the NS. Primary anterior septoplasty corrects only the anterior aspect of the NS in most children with CL and CLP. However, the posterior aspect of the NS remains deviated. A posterior deviation is likely to lead to nasal obstruction therefore regular monitoring is required all along the growing period.

Objective and Subjective Outcomes Following Radiofrequency of Inferior Turbinates in Patients with Sleep-Disordered Breathing.

Nasal obstruction is a frequent problem amongst patients with sleep-disordered breathing (SDB). Radiofrequency of the inferior turbinates (RFIT) is commonly utilized for inferior turbinate (IT) reduction but its effectiveness in SDB patients remains unproven. We aim to evaluate long-term objective and subjective nasal, olfactory and sleep outcomes following RFIT in SDB patients. Patients were assessed at baseline (T0) and at 3 months (T1), 6 months (T2) and 12 months (T3) following RFIT. At T0, T1, T2 and T3, the patients underwent objective assessments of their nasal airways and smell function and an evaluation of their quality-of-life, sinonasal, olfactory and sleep symptoms. Sleep studies were carried out at T0 and T2. Seventeen patients (with a median age of 42 years) underwent RFIT. A statistically significant objective and subjective improvement of the patients' nasal airways was demonstrated at T1. No other statistically significant changes were observed in the patients' nasal airways, smell, sleep study parameters or patient-reported outcomes at the other follow-ups. A multivariate analysis confirmed a statistically significant influence of age (older), sex (male), a higher BMI, the presence of septal deviation and the presence of allergic rhinitis in some of the studies' parameters. A statistically significant objective and subjective improvement of the patients' nasal airways was confirmed in the fitted model when considering the influence of the available variables. Our study confirms that the benefits of RFIT alone in SDB patients are limited and possibly only in the short-term period. Patient-related variables can potentially influence the final outcomes.

The effect of nasal septal deviation on maxillary sinus volume in patients undergoing septoplasty surgery

Background: In this sudy, we aimed to determine the association between nasal septal deviation and maxillary sinus volume in patients undergoing septoplasty. Materials and Methods: 164 paranasal sinus computed tomography (PNS CT) of the patients(80 female, 84 male) undergoing septoplasty surgery were retrospective evaluated between September 2022 and September 2023. Bilateral maxillary sinuses volüme (MSV) and septal deviation angle(SDA) were calculated using the computed program. SDA was divided into right and left, also was described as mild, moderate, or severe. Results: The mean of right MSV was measured as 14.34 ± 3.91 (7.45-23) and the mean of left MSV was 15.11 ± 4.29 (6.34-24.3). The average SDA of all patients was 15.51 ± 5.22 (6.7-34). The difference between right and left MSV was measured lower in patients with mild septal deviation than in patients with moderate or severe septal deviation (p=0.016, p=0.024, respectively). In the evaluation made according to MSV, the difference values between ipsilateral MSV, contralateral MSV, total MSV and right-left MSV according to the side of septal deviation were found to be higher in men than in women (p=0.011, p=0.001, p=0.004, p

Deciphering nasal septum deviation: Computed tomography insights into age and gender trends for optimized clinical care

Background: Deviation of the nasal septum (DNS) is defined as any deviation of the septum from the midline and is one of the most common variations of the sinonasal anatomy. Aims and Objectives: The purpose of this study was to observe the prevalence of DNS and its relation with age, gender, and sidedness. Materials and Methods: Sinonasal computed tomographic images of 100 subjects obtained from the Department of Radiodiagnosis, King George’s Medical University, Lucknow, UP, in the period August 2013–July 2014 were analyzed to determine the prevalence of DNS and its relation with age, gender, and sidedness. Results: Of a total of 100 subjects, normal midline nasal septum was seen in 27 subjects whereas 73 subjects (73%) displayed a deviation in its position. The prevalence of nasal septal deviation (NSD) was significantly higher in females (84.21%) as compared to males (66.13%) (P=0.048). We also compared the prevalence of NSD in different age groups and found it to be higher in subjects aged &gt;46 years (83.33%) as compared to other age groups but this difference was not found to be statistically significant (P=0.619). Conclusion: Nasal septu the septum toward the right. No correlation between age intervals and prevalence of DNS was found.

Sinonasal Anatomic Variations in the Adult Population: CT Examination of 1200 Patients.

The nasal cavity and paranasal sinuses are one of the most frequently anatomically varied regions. Their size and shape vary from person to person, and ethnic origin may have a role in this variety. Recognizing this variations is so important for ear nose throat (ENT) specialists because they predispose to sinonasal pathologies and affect the complication rate and success of endoscopic sinus surgery. This study aimed to determine the frequency of sinonasal anatomic variations on paranasal sinus computed tomography (CT) in the Turkish population. Patients who had undergone paranasal sinus CT with any complaints between 2013 and 2020 and aged over 18 years were included in the study. A total of 1209 patients who had undergone paranasal sinus CT were examined for coronal, axial, and sagittal plans retrospectively by two ENT professionals, and anatomical variations were evaluated. To assign the frequency of anatomic variations in a healthy population, patients who had previously undergone paranasal sinus and nasal surgery, who had nasal polyposis, and for whom CT evaluation was not possible due to intense sinusitis were excluded from the study. Among 1209 patients, 644 were male and 565 were female. The mean age of the patients was 33.7 years. The most common sinonasal anatomical variations were nasal septal deviation and agger nasi cells, while the least common variation is the supreme turbinate. No variation was found in 48 (3.9%) CTs. Almost all patients had at least one sinonasal anatomical variation. These variations should be known by the professionals who have interest in sinonasal disease and surgery.

Dorsal Preservation Rhinoplasty Using a Ferreira-Nakamura Spare Roof Technique B Highlighting the Low Septal Cartilage Strip.

Dorsal preservation rhinoplasty techniques can be surface or foundation techniques and respect the philosophy of preserving the osteocartilaginous nasal vault. A spare roof technique (SRT) aims to preserve the upper lateral cartilages through surface techniques. In tension noses with considerable caudal septum deviations, the septal can be repositioned after a low strip of septal cartilage is removed, and the SRT-B is used to reduce the osteocartilaginous hump. This inclusion of the low septal cartilage strip in the SRT-B rhinoplasty is termed as SRT-B3 and builds upon the previously reported philosophy advocated in SRT-A and SRT-B. Correction of moderate deviations of the nasal axis and/or the caudal septum can be addressed with this modification.

Impact of septal deviation and turbinate hypertrophy on nasal airway obstruction: insights from imaging and the NOSE scale: a retrospective study

BackgroundThe aim of this study was to evaluate the effects of nasal septum deviation and inferior turbinate hypertrophy on nasal obstruction by utilizing the Nose Obstruction Symptom Evaluation (NOSE) values and paranasal sinus computed tomography (PSCT) findings for correct preoperative evaluation.MethodsNinety-six patients (57 males and 39 females) aged between 18 and 54 years (mean age, 30.3 ± 9.7 years) participated in this study. Among them, 56 patients underwent septoplasty combined with inferior turbinate outfracture, while 40 patients underwent septoplasty alone. Preoperative nasal examinations were performed on all patients. The direction, location, nasal septum deviation classification, and inferior turbinate hypertrophy size classification were carefully evaluated and compared with the NOSE survey results. PSCT of 56 patients were evaluated and classified by calculating the coronal location of septum deviation, the axial location of septum deviation, the coronal angle of septum deviation, and the axial angle of septum deviation.ResultsA positive correlation was found between the coronal location of the septal deviation and the preoperative NOSE 2, and the NOSE total, and the difference of postoperative and preoperative NOSE (p = 0.032, p = 0.007, p = 0.021, respectively). There was a statistically significant relationship between the coronal location of the septal deviation classification and the NOSE preoperative total values (p = 0.26). A negative statistically significant correlation was found between inferior turbinate hypertrophy and preoperative NOSE 5 values (p = 0.029).ConclusionWe conclude that the combination of PSCT and the NOSE scale is helpful in determining the severity of nasal obstruction prior to surgery. Specifically, we found that nasal septum deviations located in the anterior and coronal planes have a greater impact on nasal obstruction compared to deviations in the axial plane. Inferior turbinate fracture does not provide more benefit than septoplasty alone in treating patients’ nasal obstruction. These findings emphasize the importance of a comprehensive approach in addressing nasal obstruction for optimal patient outcomes.

Using cone-beam CT for appropriate nostril selection in nasotracheal intubation.

Nasotracheal intubation is a standard blind procedure associated with various complications. The selection of the appropriate nostril is crucial to preventing most of these complications. The present study aimed to evaluate the predictive ability of cone-beam CT (CBCT) images to select the correct nostril for nasotracheal intubation. The study encompassed 60 patients who underwent maxillofacial surgery with nasotracheal intubation under general anaesthesia. While the anaesthetist made the appropriate nostril selection clinically according to a simple occlusion test and spatula test, the radiologist made the selection after analysing various CBCT findings such as the angle and direction of nasal septum deviation (NSD), minimum bone distance along the intubation path, and the presence of inferior turbinate hypertrophy. The appropriateness of these choices made blindly at different times was evaluated using descriptive statistics, chi-squared test, and independent samples t-test. The study found that 83.3% of the suggested nostril intubations were successful. We also observed that intubation duration was longer when inferior turbinate hypertrophy was present (P = .031). However, there was no statistical relationship between the presence of epistaxis and septal deviation (P = .395). Nonetheless, in 64.3% of cases with epistaxis, the intubated nostril and the septum deviation direction were the same. Pre-operative evaluations using CBCT can aid anaesthetists for septum deviation and turbinate hypertrophy, as both can impact intubation success rates and duration.

Pre-Operative Planning of a DCR Surgery Using Virtual Reality

ABSTRACT Purpose To assess a novel Virtual Reality (VR) tool designed to enhance understanding of the nasal anatomy in patients eligible for DCR surgery. Methods Preoperative Computed Tomography (CT) scans of the orbit were obtained and loaded as DICOM (Digital Imaging and Communications in Medicine) files onto the D2P software (3D Systems Inc. Littleton, CO) for tissue segmentation and 3D model preparation. Segmentation was performed on several anatomical structures, including the skull, lacrimal sac, nasal septum, inferior and middle turbinate. The resulting 3D model was visualized using a VR headset. After completing the segmentation procedure, ten cases were evaluated by a panel of six surgeons, including both senior and resident physicians from ENT and oculoplastic specialties. Results The dataset under examination comprised images from 10 preoperative CT scans of the orbits of patients eligible for Endo-DCR. When evaluating the CT using the VR tool, in 73.3% of the cases ENT surgeons were right about the side of pathology, while only 43.3% ophthalmologists were right (chi-square, p = .018). In 72.8% of the cases ENT surgeons were evaluated right that there is a septum deviation, while only in 47.2% of the cases the ophthalmologists were right (chi-square, p = .094). When evaluating the CT using the VR tool, in 60% of the cases consultants were right about the pathology, while 57.7% of the residents were right (chi-square, p = .853). In 81.7% of the cases consultants were evaluated right that there is a septum deviation, while only in 58.3% of the cases the ophthalmologists were right (chi-square, p = .198). Discussion ENT surgeons, as well as consultants, interpreted the CT better than the ophthalmologists and residents. Surprisingly, the VR system did not help them to interpret the CT better. Further, more extensive studies should be done to build a VR system that assists in the correct interpretation of the preoperative CT before DCR surgery as well as during DCR surgery.