Nasal Septal Deformity Research Articles

Comparative characteristics of the nasal airflow aerodynamic parameters in patients with nasal septum deformation and healthy participants

Comparative characteristics of the nasal airflow aerodynamic parameters in patients with nasal septum deformation and healthy participants

INDICATORS OF MUC 5AC AND MUC 1 MUCOPOLYSACCHARIDE EXPRESSION IN THE NASAL MUCOSA OF PATIENTS WITH POSTNASAL DRIP SYNDROME AND NASAL SEPTUM DEVIATION

Introduction. Determining the cause of postnasal drip syndrome can be quite challenging. Nasal septum deformation has been recognized as one possible factor. Understanding the fundamental processes of postnasal drip syndrome is crucial for developing targeted therapeutic strategies for treating this pathology. In our study, we examined the clinical and histological features of postnasal drip syndrome in individuals with nasal septum deformation and investigated the expression of mucopolysaccharides, specifically the indicators of MUC 5AC and MUC 1.
 The aim. This study aims to investigate the clinical and histological aspects of postnasal drip syndrome (PNDS) in patients with nasal septum deformation. Specifically, the study aims to explore the expression levels of MUC5AC and MUC1 in biopsies of the nasal turbinate mucosa.
 Materials and methods. A total of 29 samples of nasal mucosa from the lower nasal turbinates were collected. These samples were divided into two groups: patients with nasal septum deviation with and without postnasal drip syndrome. Levels of MUC5AC and MUC1 were determined using Western blot analysis.
 Results. Upon analysis of histological sections, we identified a significant increase in tissue metaplasia and lymphoid infiltration in the nasal mucosa of patients with postnasal drip syndrome compared to the control group. The levels of mucopolysaccharides, MUC5AC and MUC1, were higher in the nasal mucosa of the research group compared to the control group.
 Conclusions. The obtained data suggest that anatomical changes in the nasal cavity may play a role in the development of postnasal drip syndrome through alterations in mucin secretion.

Nasal septum deviation with severe obstruction

The nasal septum is a nasal structure that is anatomically and physiologically has a very important role. Various degrees of nasal septal deformity are present at birth and are thought to increase with age. The diagnosis of septal deviation is established based on clinical symptoms, physical examination and supporting examinations. Investigations such as nasoendoscopy, paranasal sinus X-ray, computer tomography, Peak Nasal Inspiratory Flow (PNIF), Rhinomanometry and Acoustic Rhinometry can be performed to assess the anatomical structure of the nose, nasal obstruction caused, as well as complications from septal deviation. An 18-year-old man came to the ENT clinic at Sanglah Hospital Denpasar with complaints of an aquiline nose since two years ago. Complaints are accompanied by complaints of nasal congestion and headaches. Two years ago, the patient was hit on the nose by his friend. Assess complaints of nasal obstruction using the Nasal Obstruction Symptom Evaluation (NOSE) score to get a score of 60. In this case, the open septoplasty technique was chosen because the patient had a severe degree of nasal obstruction, often had headaches, and the patient also complained of cosmetic problems because the deviation to the contralateral side was evident on the outside of the nose.

Efficacy of Nostril Supportive Splint Treatment for Nasal Septum Deformities after Le Fort I Osteotomy.

This retrospective study aimed to evaluate the efficacy of support splint treatment for deformities and deviations of the nasal septum after Le Fort I osteotomy (LFI). Patients were divided into two groups: the retainer group wore a nasal support splint immediately after LFI for 7 days, and the no retainer group did not wear a nasal support splint. Evaluation was performed by measuring the ratio of the difference between the left and right sides of the nasal cavity area (ratio of nasal cavity) and the angle of the nasal septum using three computed tomography frontal images (anterior, middle, and posterior) before and one year postoperatively. Sixty patients were included and divided into two groups, the retainer and no retainer group (n=30 each). Regarding the ratio of nasal cavity on middle images at one year postoperatively, the retainer and no retainer groups differed significantly (0.79±0.13 and 0.67±0.24, respectively; P =0.012). The angle of the nasal septum on anterior images at one year postoperatively was 164.8±11.7° in the retainer group and 156.9±13.5° in the no retainer group, showing a significant difference ( P =0.019). This study suggests that support splint treatment after LFI is effective in preventing post-LFI nasal septal deformation or deviation.

Endoscopic Septoplasty: A Retrospective Analysis of Indications and Outcome.

Endoscopic septoplasty is a minimally invasive surgical procedure for the correction of nasal septal deformity. Globally, nasal septal surgeries are rarely performed, and in our country these procedures are even more scarcely undertaken, partly due to dearth of facilities and to some extent, the expertise of embarking on this specialised surgical procedure. Therefore, we aimed to document the indications and the outcome of endoscopic septoplasty in our environment. This was a retrospective study of all consecutive patients that had endoscopic septoplasty at a state tertiary hospital over three years period. Ethical approval was obtained before commencement of the study. Patients' medical records were retrieved. Biodata, clinical presentation, operative procedure and outcome were extracted and analyzed descriptively. Fourteen patients had endoscopic septoplasty over the period under review, constituting 11 (78.6%) males and 3 (21.4%) females. Predominant clinical features were nasal obstruction (100%) and nasal septal deviation (100%). The main indication for procedure was deviated nasal septum. The outcome of the surgery was good, 2(14.3%) of the patients had nasal adhesions but no major complication was recorded. The length of hospital stay ranged between 3 and 5 days with a mean of 3.7 ± 0.9 days, and all the patients were discharged successfully. Endoscopic septoplasty is a safe surgery. The main indication for the procedure was deviated nasal septum, and the procedure has a favourable outcome among the operated patients.

Association Between Anterior Rhinoscopic/Endoscopic Assessment of Internal Nasal Valve and Various Nasal Deformities in the Rural Population of Vidarbha Region of India: A Cross-Sectional Study.

Background The nasal valves constitute the majority of the nasal cavity's resistance. Any reduction in this already narrow area can cause a significant reduction in the nasal airflow. In this present study, the aim was to do an endoscopic assessment of the internal nasal valve (INV) in patients with various nasal septal deviations, with or without external nasal deformity. We measured endoscopically the INV in various nasal deformities and derived its association with the INV on anterior rhinoscopy and endoscopic assessment. Method We included 75 patients in the study who were analyzed for angle and grade of the INV by anterior rhinoscopic examination and Hopkins rod zero-degree nasal endoscope (Karl Storz SE & Co., Tuttlingen, Germany). Nasal septal deviations were also studied with respect to the Mladina classification. Correlation between various nasal septal deviations with the INV was done. Since studies addressing the classification of INV are not available in the literature, for the purpose of simplification of observation of INV angle, (normal range 9-15 degrees), subjective stratification was made in the study, i.e.below 9, 9-15, and more than 15 degrees for the sake of knowing the underlying cause and its relationship. Result An anterior rhinoscopic examination was performed on 75 patients. INV Grade 1 was the most common, with 18 patients of (69.2%), 15 patients of DNS with caudal dislocation (55.6%), five patients of DNS with spur (38.5%), and four patients of DNS with external nasal deformity (50%). The next frequently observed Grade of INV on anterior rhinoscopy examination was Grade 2, in 11 patients of DNS with caudal dislocation (40.7%), four patients of DNS with spur (30.8%), and three patients of DNS with external deformity (37.5%), which was statistically significant in our study. In the majority of patients with all types of nasal septal deviations with or without external nasal deformity, INV (angle) of less than 9 degrees was noted, which was statistically significant. A linear relationship, ie., Grade 0 INV in Type I, Grade 1INV in types II, III, IV, and V, and Grade 2 in Type VII was observed. Our study is on par with the literature questioning the dogma of the normal angle of INV being 9-15 degrees. Conclusion We were able to establish a positive and complimentary role of anterior rhinoscopic and endoscopic assessment of INV. The proposed novel classification of the angle of INV by endoscopic assessment gives a better insight into the association of INV with various nasal septal deformities with or without external nasal septal deviation.

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 likeDNS, 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 reviewshows that not all subtypes of DNS always result in the development of CRS. Only extremely severe DNS appearsto contribute to the etiology of CRS.

Unilateral Blindness in Post Septoplasty Due to Homocysteinemia: A Rare Presentation.

Septoplasty is a common operative procedure in ENT for correction of nasal septal deformity. Rarely it may result into devastating complication like vision loss. This may be related to other causes apart from septoplasty. The author presents a 27yrs old male admitted to our hospital for septoplasty, 1h after septoplasty the patient suffered from unilateral vision loss. After thorough examination and investigation the vision loss was found to be due to homocysteinemia. Hence homocysteinemia is one of the rare cause of vision loss in post septoplasty. Thus this is a rare presentation.

Modern concept of etiopathogenesis, and treatment of nasal septum deformation combined with phyalystonic tongue hyperplasia in children

The article looks into the issues of etiopathogenesis and surgical treatment of children with deformity of the nasal septum, combined with hypertrophy of the nasopharyngeal tonsil. The article reflects the negative impact of adenoid vegetations and deformities of the nasal septum on the functional state of the nose, nasopharynx, and auditory tube in childhood. Analysis of the literature indicates, that there is no consensus regarding the surgical treatment of deformities of the nasal septum, combined with hypertrophy of the pharyngeal tonsil. The development of more effective methods of surgical treatment remains open.

ПОСЛЕОПЕРАЦИОННАЯ ДИНАМИКА ПОКАЗАТЕЛЕЙ ФУНКЦИОНАЛЬНОГО СОСТОЯНИЯ НОСА У БОЛЬНЫХ С ДЕФОРМАЦИЕЙ НОСА, СОЧЕТАННОЙ С ПАТОЛОГИЕЙ ПОЛОСТИ НОСА И ОКОЛОНОСОВЫХ ПАЗУХ

Objective: To study dynamical changes in the functional state of the nose in patients with nasal deformity (ND) in combination with diseases of the nasal cavity (DNC) and paranasal sinuses (PNS) before and after single-step surgical treatment. Methods: The functional state of the nasal cavity was studied in 184 patients with ND in combination with DNC and PS in patients aged 16 to 45 years. The patients were divided into two groups of 92 people each. Group 1 consisted of patients with ND and nasal septum deformity (NSD) combined with DNC, and group 2 consisted of patients with ND and NSD combined with the DNC and PNS. The study included rhinoscopy, PNS CT scan, rhinomanometry, olfactometry, and analysis of the average duration of mucociliary transport (MCT). In addition, 184 septoplasties, 96 ultrasound turbinate reductions, 48 submucosal vasotomies, 17 nasal turbinate resections, 15 polypectomies/ethmoidectomies, 8 maxillotomies, and 184 rhinoplasties were carried out as a single-stage procedure. Results: It was revealed that significant impairment of the nose's respiratory, olfactory, protective, and aesthetic functions occurs with ND combined with DNC and PNS. Six months after single-step surgical interventions, the restoration of nasal breathing was observed in 94.6% and 91.3% of patients in groups 1 and 2, respectively. At the same time, in 96.7% and 92.4% of patients in groups 1 and 2, respectively, the sense of smell returned to normal. In addition, normalisation of MCT duration was noted in 92.4% and 89.1% of patients in groups 1 and 2, respectively. Although there were no statistically significant differences in the parameters between the groups, the changes in all the studied dynamic parameters over the observation period in both groups were statistically significant (p<0.01). Conclusion: The obtained results show the effectiveness of single-stage operations compared to multi-step procedures and the feasibility of their implementation in cases of ND in combination with DNC and PNS. Keywords: Paranasal sinuses, nasal deformity, nasal septum deformity, turbinate hypertrophy, one-stage operations, mucociliary transport.

Long-term efficacy and safety of 3D printed implant in patients with nasal septal deformities.

To investigate the long-term safety and efficacy of a 3D-printed bioresorbable polycaprolactone (PCL) nasal implant for nasal septal deformity reconstruction. Fourteen patients who had undergone nasal septum reconstruction surgery using 3D-printed PCL nasal septal implants were enrolled. The primary outcome was the change in total Nasal Obstruction Symptom Evaluation (NOSE) scale scores between postoperative 3months and current status (3.59 ± 0.51years). The secondary outcomes were changes in the minimum cross-sectional area (MCA) and volume of both nasal cavities based on acoustic rhinometry, the cross-sectional area of the ostiomeatal unit, and the nasal septum angle of the paranasal sinus (PNS) in computed tomography (CT) images, and a visual analog scale (VAS) of the patients' subjective satisfaction. The results showed no significant changes in the MCAs (Cohen's d:0.09; p = 0.711) or nasal volume (Cohen's d:0.26; p = 0.356), the area of the ostiomeatal unit (Cohen's d:0.49; p = 0.064), septum angles (Cohen's d:0.18; p = 0.831), the NOSE scale (Cohen's d:0.14; p = 0.621), or patients' subjective satisfaction (Cohen's d:0.52; p = 0.076) during the follow-up period. This homogeneous composite microporous PCL nasal septal implant demonstrated long-term clinical efficacy and safety in human tissues that required maintenance of mechanical strength. Therefore, the indications for this implant could extend to various other craniofacial reconstructions in the future.

Treatment of the Middle Third and Septal Deformity: A Trizonal Approach.

Genetic, developmental, traumatic factors can produce a wide variety of nasal septal deformities in caudal-cephalic/dorsal-maxillary planes alone or in combination. These can be corrected by an endonasal approach through a transfixion incision by resecting, transposing, or utilizing principles of cartilage biomechanics. The authors are proposing a "Rosetta Stone" based on a trizonal analysis of the deviated nose that considers the contribution of each region to the deformity. Clinical assessment of the deviated nose should be segmental as well as global. Surgical correlation of the nasal bones, perpendicular, and quadrilateral plates, lateral cartilages, and turbinates may be necessary to achieve a satisfactory cosmetic and functional results.

Nasal Septal Deviation and Incidental Paranasal Sinus Opacification: A Role of Computed Tomography

Background and Objectives: The purpose of this study was to investigate the prevalence of incidental paranasal sinus (PNS) opacification in nasal septal deviation (NSD) using computed tomography (CT) and to identify contributing factors.Subjects and Method: We analyzed 216 patients who underwent septoplasty for the correction of NSD and who underwent preoperative PNS CT. We assessed the prevalence of incidental PNS opacification in these patients and determined the type of NSD according to Mladina classification. We also evaluated whether the direction of NSD affected the presence of PNS opacification on CT, and whether the presence of PNS opacification was associated with other rhinologic symptoms.Results: Of 216 patients with NSD, 86 showed opacified PNS on CT. According to Mladina classification, NSD patients were classified as type I (24.1%), type II (36.1%), type III (20.8%), type IV (5.6%), type V (9.7%), type VI (2.3%), or type VII (1.4%). Patients with type II NSD showed a significantly higher incidence of PNS opacification compared with other types of NSD (p=0.001). However, the direction of NSD did not significantly influence the presence of incidental PNS opacification. Furthermore, regardless of the presence of PNS opacification, there was no significant difference in rhinologic symptoms such as olfactory dysfunction, among others.Conclusion: We found that incidental PNS opacification on CT was common in NSD patients, especially in patients with type II NSD. Thus, we suggest that CT evaluation of patients with NSD may be helpful for assessing comorbid PNS pathologies as well as objectively identifying nasal septal deformities.

Use of Biodegradable Implant in Rhinoplasty and Nasal Septum Surgery

The nasal septum has a significant influence on the form and function of the nose, as it is a key element of the nasal framework. Its shape, size, position, and integrity help determine not only the patency of the nasal fossae but also the appearance of the nasal pyramid. Achieving satisfactory functional and aesthetic results presents a real challenge for the surgeon in a wide range of nasal septal deformities. During the last decade, the absorbable biodegradable plate DePuySynthes Rapidsorb fixation system has been used to repair pediatric facial fractures. It provides stability during the initial period of healing until the bony fracture segments have reunited. There are many differently sized and shaped plates with varying thickness available. We believe this is a useful technique to improve the rate of septoplasty success, and with further experience, the indications and role in septal surgery can be better defined.

Septoplasty by disarticulation

The difficulty of correcting nasal septum deformities using the classical Killian or Cottle techniques or derivatives has led in recent years to new suggestions such as extracorporeal septoplasty or various apposition grafts to counteract refractory deformity of the quadrangular cartilage. Naturally occurring septal deformities result from conflicts in growth between the quadrangular cartilage, perpendicular ethmoidal plate and vomer, which each have their own different evo-devo origin. Septoplasty by disarticulation consistently restores a level septum by completely resolving the growth conflicts. Conserving the quadrangular cartilage is essential for the stability of the nasal pyramid on condition that 1) the lateral flare of the superior edge of both the component septolateral cartilages that suspend it at the roof of the piriform orifice and 2) the height of its anterior edge are respected. The anterior edge is always high enough (except in case of fracture or malformation to project the retrolobular nasal dorsum in proportion to the height of the alar cartilage when it is repositioned on its natural premaxillary base.

Extracorporeal septorhinoplasty: Technical note

Severe nasal septal deformities can be responsible for functional and aesthetic impairments. Correction of these deformities can be difficult and restoring perfect nasal shape and function is still challenging. Classical techniques can, sometimes, lead to disappointing results or relapse. In this article, the aim was to describe the different techniques of extracorporeal septorhinoplasty and fixation of the neoseptum. Three techniques are mainly used: “crisscross” suture, “U-shaped” suture and anterior septal reconstruction to fix the neoseptum after extracorporeal remodeling. All these techniques are technically demanding, especially concerning keystone area management; but, if well performed, could give satisfactory functional and aesthetic outcomes. We therefore think that extracorporeal septorhinoplasty should really improve our results concerning functional and aesthetic aspects in case of severe anterior or caudal septum deviation.

Competitive study of conventional septoplasty versus endoscopic septoplasty

Objective: Traditional surgeries of the nasal septum improve the nasal airway but recent developments of endoscopic techniques have brought focus over several aspects of possible advantages over traditional techniques. These are due to better visualization and illumination, better accessibility and evaluation of exact pathology, the lesser need for unnecessary manipulation, resection and overexposure of the septal framework, and improving the scope for revision surgery if required later. Materials and methods:A hundred cases of the deviated nasal septum (DNS) refractory to conservative medical treatment were divided into two groups and underwent corrective surgery for nasal septal deformity using both endoscopic and conventional techniques. These patients were divided into two groups who underwent septal surgery with two different techniques and the results were compared. All patients were followed up in the outpatient and were assessed for subjective improvement.Time taken for the study was four months. Results:A hundred patients with deviated nasal septum were recruited into a study where the patients were divided into two groups, 50 cases in each group. Group I underwent conventional septoplasty while group II underwent an endoscopic septoplasty. The most prevalent complaint in the patients was nasal obstruction (88%), headache (60%), nasal discharge (54%) and sneezing (44%). The postoperative follow-up of the frequency of symptoms after surgery showed relive of nasal obstruction in 70% of cases of group I and in 92% of group II. However, the headache was relieved in 73% of cases of conventional septoplasty and 90% of cases of endoscopic septoplasty. Conclusion: The clinical results of endoscopic septoplasty were found better as compared to conventional techniques with lesser complications and lesser periods of hospitalization.The use of endoscopic techniques offers lesser complications and lesser periods of hospitalization.

Side asymmetry in nasal resistance correlate with nasal obstruction severity in patients with septal deformities: Computational fluid dynamics study.

The objective of this study was to investigate the relationship between side asymmetry in nasal resistance (NR) and severity of the nasal airway obstruction (NAO) in patients with different types of nasal septal deformity (NSD). Computational fluid dynamics (CFD) study. The study was conducted in a tertiary medical centre. The study included 232 patients, who were referred to the CT examination of the paranasal sinuses. Exclusion criteria were sinonasal and respiratory diseases that may interfere with the nasal obstruction. The presence and the type of NSD were recorded according to the Mladina's classification. The presence and severity of NAO in each patient were assessed by NOSE questionnaire. Eight computational models of the nasal cavity were created from CT scans. Models represented seven Mladina's NSD types and a straight septum of a symptomless patient. CFD calculated airflow partitioning and NR for each nasal passage. Side differences in NR were calculated by the equation ∆NR=NRleft -NRright . The relationship between NOSE scores, airflow partitioning and side differences in NR was explored using Spearman's correlation analysis. Mladina's types of NSD showed differences in airflow partitioning and the degree of side asymmetry in NR. A significant positive correlation was detected between side differences in NR and NOSE scores (R=.762, P=.028). A significant negative correlation was found between the per cent of unilateral airflow and NR (R=-.524, P=.037). Our results demonstrated that side asymmetry in NR could explain differences in NAO severity related to the NSD type.

The effect of deviated nasal septum on aesthetic appearance of the nose

Background The deviated nasal septum affects the aesthetic appearance of the nose, as a well-known phrase projects ‘As the septum goes, so goes the nose.’ The nasal septum is the central structure supporting the framework of the nose. Aim To evaluate the relationship between nasal septum deformities and its effects on aesthetic appearance of the nose, and the management of each effect. Patients and methods A total of 30 patients who underwent septorhinoplasty between April 2016 and December 2019 were evaluated prospectively. This was done in Al-Zahraa University Hospital. Patients who had nasal deformities owing to septal deformities were included. Results Regarding interference with nasal septum in rhinoplasty operation, only two (6.7%) cases were done without septoplasty, whereas 28 (93.3%) cases were done with septoplasty. In 93.33% of the cases, nasal septum affected the shape of the nose, and in only 6.67% of the cases, the nasal septum did not affect the shape of the nose. Conclusion The deviated nasal septum affects the aesthetic appearance of the nose, but not all parts of septum affect it. Bony part does not affect the shape of the nose and not all types of deviations of the septum. However, deviations that reach the dorsum of the nose or columella surely affect the shape of the nose.

Функциональное состояние полости носа после эндоскопической септопластики

Septoplasty is one of the three most frequently performed operations in otorhinolaryngology. The history of the development has more than 200 years. The research and analysis of the features of different methods of this surgical treatment does not lose interest to this day. The article presents an analysis of the restoration of the functions of the nasal cavity after septoplasty. The research included 96 patients with various types of nasal septum deformities. The age range of patients ranged from 19 to 54 years. All patients had nasal septum correction under general anesthesia. Patients were divided into 2 groups. The 1st group included 64 patients who had endoscopic septoplasty. The 2nd control group consisted of 43 patients with the same pathology who underwent classical septoplasty without optical control. Dynamic observation was carried out before surgical treatment, on the 7th day, 1, 3, 6, 12 months after surgery. The aim of the research was to estimate the functional status of the mucous membrane of the nasal cavity after surgery, the time of the operation, as well as long-term postoperative complications if any. The following diagnostic measures there were: complaints, otorhinolaryngological examination by using endoscopic techniques, anterior active rhinomanometry on the Rinolan device (manufactured by Lana-Medica), measurement of mucociliary transport time using the saccharin test. Comparative analysis of groups of patients showed no significant difference in the restoration of nasal cavity functions. However, performing septoplasty using endoscopic technique reduces the time of surgery and the percentage of complications in contrast to the classical septum surgery