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New Description Method and Classification System For Septal Deviation
New Description Method and Classification System For Septal Deviation
Original Article
Department of Otorhinolaryngology, Seoul National University, College of Medicine, Boramae Hospital, Seoul; and
2
Hana Otorhinolaryngology Clinic, Cheongju; and
3
Department of Otolaryngology, Chungbuk National University Hospital, Cheongju, Korea
ABSTRACT
Background and ObjectivesThe purpose of this study is to develop an efficient method of description and a new classification system for septal deviations (SD) and to study the applicability of the new description method and classification system to a
clinical setting. Materials and MethodsSixty-five patients with nasal obstruction (symptomatic group) and thirty-five
patients without nasal obstruction (asymptomatic group) were included in this prospective study. The characteristics of SD
were analyzed according to the new description method based on the morphology, site, severity, and its influence on the
external nose. Based on these observations, four classification categories of SD were introduced: localized deviation (type I),
curved/angulated deviation (type II), curved/angulated deviation combined with type I (type III), and curved/angulated deviation with associated dorsal nasal deviation (type IV). The incidence of each type of SD was calculated. ResultsIn both
groups, all pathologies of the SD could be precisely described using the new description method. In both groups, the curved
deviation (type II) was the most common pathology. Anterior/mid was the most common site of deviation. In the symptomatic
group, moderate was the most common form of severity while mild was the most common form in the asymptomatic group.
In both groups, type II was the most common. Types III and IV were significantly more common in the symptomatic group
while type I was predominant in the asymptomatic group (p<0.05). ConclusionThe new description method provides a
precise descriptive term for SD. The proposed classification system is suitable for documentation and determination of the
severity of SD.
KEY WORDSNasal septumClassificationNasal septal deviationDescription.
INTRODUCTION
Deviation of the nasal septum has particular significance because it is involved in almost all rhinological problems to some degree. However, commonly used descriptions such as severe septal deviation to right or left
septal spur are based on subjective descriptors, and they
do not reflect the precise morphology and location of the
septal deviation (SD). Moreover, deviation of the nasal
dorsum, which is commonly combined with SD, is usually
not addressed together.
Procedures on SD can present a great challenge even for
Address correspondences and reprint requests to Hong-Ryul Jin,
M.D., Department of Otorhinolaryngology, Seoul National University, College of Medicine, Boramae Hospital, 425 Shindaebang-2 dong, Dongjak-gu, Seoul 156-707, Korea
Tel82-2-840-2412, Fax82-2-831-2826
E-mailhrjin@paran.com
Received for publication on August 7, 2006
Accepted for publication on December 14, 2006
27
Fig. 1. Proposed descriptors for morphology of SD. Localized deviation (A), curved deviation (B) and angulated deviations (C, D) of
the septum.
ment for SD who were at least 16 years old were prospectively enrolled in the study for the application of the
new description method and classification system. Sixtyfive patients (MF=4.51, mean age=37 years) had
nasal obstruction (symptomatic group) and 35 patients
(MF=2.21, mean age=43 years) had no nasal obstruction (asymptomatic group). Patients who had chronic
nasal obstruction (more than four days a week for more
than three months) that impaired daily activities and did
not respond to medical treatment were considered to be
symptomatic. Patients with allergic rhinitis, nasal polyp,
tumor, chronic sinusitis, or other systemic diseases which
may cause nasal obstruction were excluded from the study.
Morphology, site, and severity were the key elements
in describing SD. Morphology was divided into 4 categories1) localized deviation-which includes spur (spine),
crest, and caudal dislocation (Fig. 1A)2) curved deviation-meaning convexity of the septum (Fig. 1B)3)
angulated deviation-including vertical or horizontal angulations (Fig. 1C, D)and 4) complex deviation-consisting
of more than one form of deviation.
The site of deviation was described in the three dimensions of horizontal (right, left), cephalocaudal (anterior,
central, posterior), and dorsoventral (high, mid, basal).
Anterior, central, and posterior were defined as the cartilaginous septum, the junction of bony and cartilaginous
septum, and the bony septum, respectively (Fig. 2). The
dorsoventral aspect was divided into high, mid, and low
portions in even thirds from the dorsum to the bottom
(Fig. 2).
The severity of deviation was determined after full shrinkage of the nasal cavity with 0.25% phenylephrine
spray. The severity was assigned into three grades by
measuring the distance of the most deviated portion in
reference to the imaginary midline and the corresponding
lateral nasal wall (Table 1).
We classified the various SDs into four types consider-
Description
Deviation less than half the total distance to the
lateral nasal wall
Deviation more than half the distance but less
than touching the lateral nasal wall
Deviation touching the lateral nasal wall
Description
II
III
IV
80
69
Symptomatic group
69
Symptomatic group
Asymptomatic group
40
20
0
*p<0.05
53
52
40
17
11
11
14
35
25
60
60
Asymptomatic group
22
20
13
0
Localized
deviation
Curved
deviation
Angulated
deviation
Complex
deviation
Fig. 3. The morphology of the septal deviation in the symptomatic and asymptomatic groups. In both groups, the curved
deviation was the most common form of septal deviation.
Complex deviation includes more than one form of deviation.
0
Mild
Dorsoventral
Asymptomatic
Anterior
80%
52%
Central
32%
42%
Posterior
06%
19%
High
38%
23%
Mid
86%
77%
Basal
23%
16%
RESULTS
Curved deviation was the most common pathology
which comprised 69% of both the symptomatic and asymptomatic group. Angulated deviation was found in 17%
of the symptomatic group and 11% of the asymptomatic
group, while complex deviation was found in 14% and
9% in each group, respectively (Fig. 3). Localized deviation was absent in the symptomatic group but represented
11% of the asymptomatic group.
In the symptomatic group, the most common site of
deviation was anterior (80%) followed by central (32%)
and posterior (6%) in the cephalocaudal direction, and
mid (86%) followed by high (38%) and basal (23%) in
the dorsoventral direction. More than one site of deviation
was observed in the cephalocaudal and dorsoventral directions at 18% and 47%, respectively (Table 3).
In the asymptomatic group, the most common site of
obstruction was anterior (52%) followed by central (42%)
and posterior (19%) in the cephalocaudal direction and
mid (77%) followed by high (23%) and basal (16%) in
the dorsoventral direction. More than one site of deviation
was observed in 13% and 16% of the cephalocaudal and
77
80
*p<0.05
Symptomatic group
65
Asymptomatic group
60
%
Cephalocaudal
Symptomatic
Severe
Fig. 4. Severity of septal deviation in the symptomatic and asymptomatic groups. In each category of the severity, the differences between the two groups were significant (p<0.05).
Moderate
40
*
20
11
0
Type I
20
15
Type II
Type III
6
Type III
Fig. 5. Types of septal deviation in the symptomatic and asymptomatic groups. In both groups, type II deviation was most common. Type III and IV deviations were significantly more common in the symptomatic group and type I deviation was significantly more common in the asymptomatic group (p<0.05).
DISCUSSION
There has been many attempts to establish an efficient
CONCLUSION
The new description method provides a precise description term for SD while it documents and determines the
severity of SD. The application of this system for guidance of septal surgery needs further study.
REFERENCES
6)
7)
8)
Springer-Verlag;2002. p.183-96.
9)
in aesthetic and functional nose surgery: setting criteria and establishing indications. Rhinology 1999;37:74-9.
3) Gomulinski L. Morphological aspect of septal deformations. Their
correction during complex rhinopalsties. Ann Chir Plast 1982;27:
343-9.
10)
11)