Clinical Implications of Nasal Septal Deformities

Abstract

The first attempts to systematize septal distortions have been given by Cottle who defined four groups of septal deformities: subluxation, large spurs, caudal deflection and tension septum. Fortunately, the variations of the septal deformities show a certain order, thus enabling more precise classification. Mladina was the first to make user-friendly classification of septal deformities in six basic types. He also described the seventh type, named “Passali deformity”, which presents individually, but is always a well-defined combination between some of the previous six types. Mladina types of septal deformities (SD) are divided in two main groups: so called “vertical” deformities (types 1, 2, 3 and 4), and “horizontal” ones (types 5 and 6). This classification was immediately well accepted by rhinologists worldwide and started to be cited from the very beginning. Since then it has been continuously cited increasingly more often, thus making Mladina classification a gold standard whenever clinical researches on nasal septum are concerned. More than forty clinical studies based on this classification have been performed to date. It is extremely important to make a strict distinction between the types of SD since all of them play some specific role in the nasal and general physiology in man.

Keywords

• Classification, nasal septum, nose deformities

References

1. 1. Cottle MH, Loring RM, Fischer GG, Gaynon IE. The maxillapremaxilla approach to extensive nasal septum surgery. AMA Arch Otolaryngol 1958;68:301-13. [CrossRef]
2. 2. Mladina R. The role of maxillar morphology in the development of pathological septal deformities. Rhinology 1987;25:199-205.
3. 3. Song SY, Kim IT, Chang KH, Lee KS, Kim HJ, Lim HJ. The Prevalence of Nasal Septal Deformities among Children in Kindergarten and First Grade in Anyang and Kunpo Cities. J Rhinol 1999;6:58-60.
4. 4. Van Loosen J. Post natal development of the human nasal septum and its related structures. Thesis. Erasmus Univeristy Rotterdam. The Netherlands, 2000.
5. 5. Yildirim I, Okur E. The prevalence of nasal septal deviation in children from Kahramanmaras, Turkey. Int J Pediatr Otorhinolaryngol 2003;67:1203-6. [CrossRef]
6. 6. Rao JJ, Vinay Kumar EC, Ram Babu K, Sathavahana Chowdary V, Singh J, Rangamani SV. Classification of nasal septal deviations - Relation to sinonasal pathology. Indian J Otolaryngol Head Neck Surg 2005;57:199-201.
7. 7. Min YG, Jung HW, Kim CS. Prevalence study of nasal septal deformities in Korea: results of a nation-wide survey. Rhinology 2005;33:61-5.
8. 8. Carinci F, Rullo R, Farina A, Morano D, Festa VM, Mazzarella N, et al. Non-syndromic orofacial clefts in Southern Italy: pattern analysis according to gender, history of maternal smoking, folic acid intake and familial diabetes. J Craniomaxillofac Surg 2005;33:91-4. [CrossRef]

9. 9. Oliveira AKP, Júnior EE, Santos LV, Bettega G, Mocellin M. Prevalence of Deviated Nasal Septum in Curitiba, Brazil. Int Arch Otorhinolaryngol 2005;9:288-92.
10. 10. Skitarelic NB, Vukovic K, Skitarelic NP. Comparative evaluation of conventional versus endoscopic septoplasty for limited septal deviation and spur. J Laryngol Otol 2009;123:939- 40. [CrossRef]
11. 11. Zielnik-Jurkiewicz B, Olszewska-Sosińska O.The nasal septum deformities in children and adolescents from Warsaw, Poland. Int J Pediatr Otorhinolaryngol 2006;4:731-6. [CrossRef]
12. 12. Chmielik M, Brożek-Mądry E, Chmielik LP. Influence of the type of septum deviation on some parameters in the upper airways. New Medicine 2006;3:71-3.
13. 13. Neskey D, Eloy JA, Casiano R. Nasal, Septal, and Turbinate Anatomy and Embryology. Otolaryngol Clin N Am 2009:42;193-205. [CrossRef]
14. 14. Teul I, W Zbislawski W, S Baran S, Czerwinski F. Deformation of the nasal septum in children, adolescents, and adults in Western Pomerania Province of Poland. Eur J Med Res 2009;14(Suppl 4):244-7. [CrossRef]
15. 15. Aljibori AS, Hassan AD, Alwan AM. Assessment of nasal septal deformities by anterior rhinoscopy and nasal endoscopy. Tikrit Med J 2010;16:14-20.
16. 16. Huizing EH, de Groot JAM, editors. Functional reconstructive nasal surgery. Stuttgart-New York: Thieme; 2003. [CrossRef]
17. 17. Bianco M, Sanna N, Bucari S, Carmela F, Palmieri V, Zepilli P. Female boxing in Italy: 2002-2007 report. Br J Sports Med 2011;45:563-70. [CrossRef]
18. 18. Sam A, Deshmukh Prsad T, Patil C, Shraddha J, Rashmi P. Nasal Septal Deviation and External Nasal Deformity: A Correlative Study of 100 Cases. Indian J Otolaryngol Head Neck Surg 2012;64:312-8. [CrossRef]
19. 19. Wee JH, Kim DW, Lee JE, Rhee CS, LeeCH, Min YG et al. Classification and prevalence of nasal septal deformity in Koreans according to two classification systems. Acta Otolaryngol 2012;132(Suppl 1):952-7. [CrossRef]
20. 20. Mladina R, Skitarelić NB, Skitarelić NP. The human external nose and its evolutionary role in the prevention of obstructive sleep apnea. Otolaryngol Head Neck Surg 2010;143:712. [CrossRef]
21. 21. Rehman A, Sajad Hamid, Mushtaq Ahmad, Arsalan F. Rashidl. A Prospective Study of Nasal Septal Deformities in Kashmiri Population Attending a Tertiary Care Hospital. Inter J Otolaryngol Head Neck Surgery 2012;1:77-84. [CrossRef]
22. 22. Swenson KE. Nasal septal deviation in a longitudinal growth sample. Master of Science thesis, University of Iowa, Iowa, 2012.
23. 23. Salaheldin AH. Effect of deviated nasal septum and hypertrophy of inferior turbinate on middle ear pressure. Pan Arab J Rhinology 2012;2:59-65.
24. 24. Kanu S, Baldev S, Sanjeev S, BS Verma. Endoscopic septoplasty: prospective study in 50 cases of septal nasal deformity. Clin Rhinol An Int J 2013;6:92-5. [CrossRef]
25. 25. Moore MI. Objective evidence for the efficacy of surgical management of the deviated nasal septum as a treatment for chronic nasal obstruction. Doctoral Thesis. Cardiff School of Biosciences, University of Wales, Cardiff University, Cardiff, 2013.
26. 26. Oswal V, Remacle M, Jovanovic S, Zeitels SM, Krespi JP, Hopper C. Principles and Practice of Lasers in Otorhinolaryngology and Head and Neck. Suregrey. 2nd ed. Amsterdam: Kugler Publication, 2014.
27. 27. Lin JK, Wheatley FC, Handwerker J, Harris NJ, Wong BJF. Analyzing Nasal Septal Deviations to Develop a New Classification System: A Computed Tomography Study Using MATLAB and OsiriX. JAMA Facial Plast Surg 2014;16:183-7. [CrossRef]
28. 28. Zhang Z, Fang S, Zhang Q, Chen L, Liu Y, Li K, et al. Analysis of Complications in Primary Cleft Lips and Palates Surgery. J Craniofac Surg 2014;25:968-71. [CrossRef]
29. 29. Šubarić M, Mladina R. Nasal septum deformities in children and adolescents: A cross sectional study of children from Zagreb, Croatia. Int J Ped Otorhinolaryngol 2002;63:41-8. [CrossRef]
30. 30. Mladina R, Čujić E, Šubarić M, Vuković K. Nasal septal deformities in ear, nose and throat patients: An International Study. Am J Otolaryngol 2008;29:75-82. [CrossRef]
31. 31. Mladina R, Krajina Z. The influence of the caudal process on the formation of septal deformities. Rhinology 1989;27:113-9.
32. 32. Mladina R. The influence of palato-cranial base (basomaxillary) angle on the length of the caudal process of the nasal septum in man. Rhinology 1990;28:185-9.
33. 33. Verwoerd CD, Mladina R, Nolst Trenite GJ, Pigott RW. The nose in children with unilateral cleft lip and palate. Int J Ped Otorhinolaryngol 1995;32:45-52. [CrossRef]
34. 34. Mladina R, Đanić D, Miličić D. Histological changes of the middle turbinate mucosa in various septal deformities. Riv Otolaryngol Aud Fon 1996;3:151-5.
35. 35. Mladina R, Ostojić D, Koželj V, Heinzel B, Bastaić Lj. Pathological septal deformities in cleft palate children. L’Otorinolaryngologia Pediatrica 1997;2-3:75-80.
36. 36. Mladina R, Miličić D, Đanić D. Septal deformities can influence the mucociliary transport impairment of the middle turbinate mucosa. In: Baum G, Priel Z, Roth Y, Liron N, Ostfeld EJ, eds. Cilia, Mucus and Mucociliary Interactions. Marcel Dekker, Inc., New York, 1998:219-28.
37. 37. Jurlina M, Mladina R, Dawidowsky K, Ivanković D, Bumber Ž, Šubarić M. Correlation between the minimal cross-sectional area of the nasal cavity and body surface area: preliminary results in normal patients. Am J Rhinol 2002;16:209-21.
38. 38. Mladina R, Šubarić M. Are some septal deformities inherited? Type 6 revisited. Int J Pediatr Otorhinolaryngol 2003;67:1291-4. [CrossRef]
39. 39. Mladina R, Skitarelić N, Vuković K, Subarić M, Carić T, Orihovac Z. Unilateral cleft lip/palate children: The incidence of type 6 septal deformities in their parents. J Craniomaxillofac Surg 2008;36:335-40. [CrossRef]
40. 40. Mladina R, Skitarelić NB, Skitarelić NP. Could we prevent unilateral cleft lip/palate in the future? Med Hypotheses 2009;73:601-3. [CrossRef]
41. 41. Poje G, Zinreich JS, Skitarelíć N, Đuríc Vukovíć K, Passàli GC, Passàli D, et al. Nasal septal deformities in chronic rhinosinusitis patients: clinical and radiological aspects. Acta Otorhinolaryngol Ital 2014;34:117-22.
42. 42. Cingi C, Bayar Muluk N, Acar M, Skitarelić N, Markešić J, Vugrinec O, et al. International study of the incidence of particular types of septal deformities in chronic rhinosinusitis patients: The outcomes from five countries. Am J Rhinol Allergy 2014;28:404-13. [CrossRef]