Does the Side of Deviation of Nasal Septum have Concomitant Predictive Relation with Side of Sphenoid Septum Deviation?

Abstract

Introduction: The asymmetric hidden sphenoid sinuses get separated by a bony septum which rarely lies in the median plane. Deviated Nasal Septum (DNS) formed by bony and cartilaginous parts can be identified by clinical examination. Paucity of literature about the concomitant side deviation of both the septum, has been found. Aim: To find the predictive relation between the side deviation of nasal and sphenoid septum. Materials and Methods: A cross-sectional study was undertaken with coronal CT image sets of paranasal air sinuses at Chennai Medical College Hospital and Research Centre, Trichy, Tamil Nadu. Images of subjects above 18 years of age without chronic sinusitis blocking Infundibulo-osteal complex, space occupying lesion, previous sinonasal surgeries, and inflammatory polyps were included from December 2016 to January 2017. In 130 source image sets, side deviation of the nasal septum and sphenoid septum were observed and categorised. The data were analysed using IBM SPSS Statistics for Windows, version 26 and a p-value of <0.05 was considered as statistically significant. The agreement of corresponding side deviation of nasal and sphenoid septum was tested using chi-square and Kappa test. Results: The DNS was noted in 94.6% (123 of 130) of images. The right, left and median deviations were observed in 50.8% (66 of 130), 43.8% (57 of 130) and 5.4% (7 of 130), respectively. The sphenoid septum deviations of right, left and median was noted in 43.1% (56 of 130), 36.9% (48 of 130), and 19.2% (25 of 130), respectively. The right deviated sphenoid septum was seen in 39 out of 66 right DNS images and left deviated in 29 out of 57 left DNS images. Chi-square showed statistical significance (p-value=0.0031) and kappa [0.231 (SE of kappa=0.064, 95% confidence interval: from 0.104 to 0.357)] was assessed as a fair agreement between the observed values. Conclusion: The fair agreement between sides of DNS with position of sphenoid septum concludes that DNS could be a probable predictor of position of sphenoid septum.

Keywords

• nasal septum deviation
• paranasal sinus
• sphenoid sinus
• tomography
• trans-sphenoid surgery