Septorinoplasti Uygulanan Hastalarda Septal Deviasyon Tiplerinin Sıklığı ve Sınıflandırılması

Öz

Amaç: Nazal septal deviasyon (NSD) paternleri genellikle şekle göre tanımlanır; ancak septorinoplasti hastalarında anatomik dağılımı ve semptomlarla ilişkisi yeterince ortaya konmamıştır. Bu çalışma (i) septal deviasyonun (SD) sıklığını, anatomik düzeylerini (yüksek, santral, taban, kaudal) ve morfolojik alt tiplerini belirlemeyi; (ii) semptomatik ve asemptomatik hastalar arasında bulguları karşılaştırmayı amaçladı. Yöntemler: Standartlaştırılmış rinoskopi/endoskopi verileri kullanılarak ardışık 378 septorinoplasti olgusu retrospektif olarak analiz edildi. NSD; lokalizasyona (yüksek, santral, taban, kaudal), kret/spur varlığına ve yeni hiyerarşik morfoloji sınıflamasına göre sınıflandırıldı: Tip I (lokalize; izole kret/spur veya kaudal dislokasyon), Tip II (septal tilt), Tip III [C-şekilli: IIIA izole anteroposterior (AP) -C, IIIB izole sefalokaudal (CC)-C, IIIC AP-C + kret/spur, IIID CC-C + kret/spur], Tip IV (S-şekilli: IVA izole AP-S, IVB izole CC-S, IVC AP-S + kret/spur, IVD CC-S + kret/spur). Bulgular: En sık santral SD görüldü (%81,2); bunu kaudal (%61,1), yüksek (%48,9) ve taban (%40,7) deviasyon izledi. Kaudal deviasyon (%74,3’e karşı %53,0; P<0,001), dış burun deformitesi (%64,2’ye karşı %50,4; P=0,009) ve septal kret (%77,7’ye karşı %62,6; P=0,002) semptomatik hastalarda daha sıktı. AP C-şekli (%38,4) en yaygın morfolojiydi; CC S-şekli (%26,2), CC C-şeklinden (%8,7) daha fazlaydı. Tüm hastalarda Tip IIIC daha sıktı ve bunu Tip IVD izledi. Asemptomatik hastalarda semptomatik hastalara kıyasla Tip IIIA anlamlı olarak daha yüksekti (%8,3 karşı %1,4; P=0,019). Sonuç: Septorinoplasti hastalarında NSD santral-dominant bir patern göstermekte olup kaudal deviasyonlar ve kretler semptomlarla ilişkilidir. Lokalizasyonu, şekli ve lezyonları entegre eden yeni sınıflama sistemimiz klinik değerlendirmeyi ve cerrahi planlamayı geliştirebilir.

Anahtar Kelimeler

• septal deviasyon
• kaudal septum
• septorinoplasti

Frequency and Classification of Septal Deviation Types in Patients Undergoing Septorhinoplasty

Öz

Aims: Nasal septal deviation (NSD) patterns are typically described by shape, but the anatomical distribution in septorhinoplasty patients—and its relation to symptoms—is not well established. This study aimed to (i) determine the frequency and anatomical levels (high, central, base, caudal) of SD and its morphological subtypes, and (ii) compare findings between symptomatic and asymptomatic patients Methods: We retrospectively analyzed 378 consecutive septorhinoplasty cases using standardized rhinoscopic/endoscopic data. NSD was classified by localization (high, central, base, caudal), presence of crest/spur, and new hierarchical morphology: Type I (localized), Type II (septal tilt), Type III [C-shape; Anteroposterior (AP) / Cephalocaudal (CC); ±crest/spur], Type IV (S-shape; AP/CC; ±crest/spur). Result: Central SD was most common (81.2%), followed by caudal (61.1%), high (48.9%), and base (40.7%). Caudal deviation (74.3% vs 53.0%, P<0.001), external nasal deformity (64.2% vs 50.4%, P=0.009), and septal crest (77.7% vs 62.6%, P=0.002) were more frequent in symptomatic patients. AP C-shape (38.4%) was the most prevalent morphology; CC S-shape (26.2%) exceeded CC C-shape (8.7%). Type IIIC was the most frequent pattern in the overall cohort, followed by Type IVD. In the subgroup comparison, Type IIIA was significantly more common in asymptomatic than in symptomatic patients (8.3% vs. 1.4%, p=0.019). Conclusion: NSD in septorhinoplasty patients shows a central-dominant pattern, with caudal deviations and crests linked to symptoms. Our novel classification system—integrating location, shape, and lesions—may enhance clinical evaluation and surgical planning.

Anahtar Kelimeler

• septal deviation
• caudal septum
• septorhinoplasty

Kaynakça

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