Clinical Adaptation According to Anatomical Types of Nasal Septum / Adaptación Clínica Según Tipos Anatómicos de Tabique Nasal

SUMMARY: The purpose of this study was to inform the anatomical types of the nasal septum of which including variations by dissection and to provide guidelines for clinical adaptation. For this purpose dissections were performed on 70 nasal septums of formalin fixed Korean adult cadavers (20 males, 11 females, and 39 of unknown sex) with an age at death of 13-105 years. The septal deviation was checked before midsagittal section the nasal cavity with the aid of a laryngoscope. The mucosa on the nasal septum was then removed to observe the morphology of the nasal septum. The shape of each component of the nasal septum was identified, and photographs were taken from a midsagittal plane. This study has discovered various anatomical types of the nasal septum and its variations. The correlations between septal types according to their proportions were also analyzed. The results reported herein provide detailed anatomical knowledge that can be used as a valuable reference for rhinoplasty procedures.

El propósito de este estudio fue informar los tipos anatómicos del tabique nasal incluyendo las variaciones por disección y brindar pautas para la adaptación clínica. Para este propósito, se realizaron disecciones en 70 tabiques nasales de cadáveres adultos coreanos fijados con formalina (20 hombres, 11 mujeres y 39 de sexo desconocido) con una edad de muerte de 13 a 105 años. La desviación septal se comprobó antes de la sección medio sagital de la cavidad nasal con la ayuda de un laringoscopio. A continuación, se retiró la mucosa del tabique nasal para observar la morfología del tabique nasal. Se identificó la forma de cada componente del tabique nasal y se tomaron fotografías desde un plano mediano sagital. En el estudio se descubrieron varios tipos anatómicos del tabique nasal y sus variaciones. También se analizaron las correlaciones entre los tipos septales según sus proporciones. Los resultados informados en este documento proporcionan un conocimiento anatómico detallado que se puede utilizar como una referencia valiosa para los procedimientos de rinoplastía.

Anatomical variations of the maxillary sinus septa of an Iranian population using cone-beam computed tomography: a retrospective study / Variaciones anatómicas de los tabiques del seno maxilar de una población iraní mediante tomografía computarizada de haz cónico: estudio retrospectivo

This study sought to assess the internal anatomy of the maxillary sinuses and their septa using cone-beam computed tomography (CBCT) in an Iranian population. Materials and Methods: Resorption of alveolar bone decreases the height of the maxillary alveolar ridge. This height reduction may be so severe that it warrants ridge augmentation by a sinus lift. Manipulation of the maxillary sinuses, as in sinus lift surgery, requires adequate knowledge about the sinus anatomy.Results: Maxillary sinus septum, as an anatomical variation, may complicate the surgical procedures and increase the risk of complications such as sinus membrane perforation. In this retrospective study, 366 sinuses, 190 from females and 176 from males, aged between 10 and 65 years old presenting to the Oral and Maxillofacial Radiology Department of School of Dentistry at Hamadan University of Medical Sciences were evaluated by two oral radiologists. The extension of the maxillary sinuses, presence of septa, number of septa and their location were determined. Data were analyzed using the chi square test (level of significance p≤0.001). The coefficient of agreement between the two oral radiologists was calculated based on Cohen kappa. Septa were present in 40.5% of the maxillary sinuses, out of which, 31.6% had one, 7.9% had two and 1% had three or more septa; 38% of the septa were horizontal while 62% had an oblique orientation. In total, 184 septa were found in 183 patients; out of which, 91 septa were 2mm to 5mm long while 93 septa were longer than 5mm. Conclusions: Comprehensive knowledge about the three-dimensional internal anatomy of the maxillary sinuses acquired by CBCT priorto surgical procedures can greatly help to prevent postoperative complications.

Este estudio buscó evaluar la anatomía interna de los senos maxilares y sus septos mediante tomografía computarizada de haz cónico (CBCT) en una población Iraní. Materiales y Métodos: . La resorción del hueso alveolar disminuye la altura de la cresta alveolar maxilar. Esta reducción de altura puede ser tan severa que justifique el aumento de la cresta mediante una elevación de seno. La manipulación de los senos maxilares, como en la cirugía de elevación del seno, requiere un conocimiento adecuado sobre la anatomía del seno. Resultado: El tabique del seno maxilar, como una variación anatómica, puede complicar los procedimientos quirúrgicos y aumentar el riesgo de complicaciones como la perforación de la membrana sinusal. En este estudio retrospectivo, dos radiólogos orales evaluaron 366 senos, 190 de mujeres y 176 de hombres, con edades comprendidas entre 10 y 65 años que se presentaron en el Departamento de Radiología Oral y Maxilofacial de la Facultad de Odontología de Hamadan University of Medical Sciences. Se determinó la extensión de los senos maxilares, la presencia de septos, el número de septos y su ubicación. Los datos se analizaron mediante la prueba de chi cuadrado (nivel de significación p?0.001). El coeficiente de concordancia entre los dos radiólogos orales se calculó en base a Cohen kappa. Los septos estaban presentes en el 40.5% de los senos maxilares, de los cuales, el 31.6% tenía uno, el 7.9% tenía dos y el 1% tenía tres o más septos; El 38% de los septos eran horizontales, mientras que el 62% tenía una orientación oblicua. En total, se encontraron 184 septos en 183 pacientes; de los cuales, 91 septos tenían de 2mm a 5mm de largo, mientras que 93 septos tenían más de 5mm. Conclusion: El conocimiento exhaustivo sobre la anatomía interna tridimensional de los senos maxilares adquiridos por CBCT antes de los procedimientos quirúrgicos puede ayudar en gran medida a prevenir complicaciones postoperatorias.

Avaliação da influência do septo nasal na expansão de maxila cirurgicamente assistida por meio de tomografia computadorizada de feixe cônico / Evaluation of the influence of the nasal septum in surgically assisted maxillary expansion using cone computed tomography

A expansão da maxila cirurgicamente assistida (EMCA) é um procedimento cirúrgico indicado para a correção da atresia maxilar em pacientes que já atingiram a maturação óssea. Os efeitos da EMCA são observados não só nos arcos dentários, maxilas e mandíbula, mas também na cavidade nasal, já que o septo nasal encontra-se localizado no centro do assoalho nasal, apoiado sobre a sutura palatina mediana. O objetivo deste estudo foi identificar a posição do septo nasal antes e após a separação cirúrgica das maxilas e avaliar sua influência na movimentação da maxila do lado que foi deslocado. Foram avaliadas 56 tomografias computadorizadas de feixe cônico (TCFC) adquiridas no tomográfo i-CAT Classic®, com voxel de 0,3mm, de 14 indivíduos submetidos à EMCA nos períodos préoperatório e pós-operatório de 15, 60 e 180 dias. Inicialmente, as imagens pósoperatórias foram visualizadas nas reformatações multiplanares, para identificar a qual maxila, direita ou esquerda, o septo nasal permaneceu ligado após a EMCA. Numa segunda etapa, foram realizadas medidas lineares nas imagens correspondentes aos períodos pré e pósoperatórios. Essas medidas foram realizadas na reformatação axial imediatamente acima do aparelho expansor, de forma padronizada para cada paciente, e consistiram da distância entre uma linha de referência central, que passava na espinha nasal anterior e no centro do forame incisivo, dividindo o paciente em lado direito e esquerdo, até os caninos e molares direitos e esquerdos. O índice kappa intraexaminador foi > 0,9. Para comparar as diferenças entre as médias dos dois grupos (lado ligado ao septo nasal e não ligado ao septo nasal) foi utilizado o teste t. Em 78,6% dos pacientes o septo nasal permaneceu ligado à maxila esquerda e em 21,4%, ligado à maxila direita. Em relação às medidas lineares, tanto na região de caninos como na região de molares, observouse que, no período pré-operatório, não havia diferença entre os lados direito e esquerdo...

The Surgically assisted rapid palatal expansion (SARPE) is a surgical procedure indicated for the correction of maxillary constriction in adult patients. The effects of EMCA are observed not only in dental, maxillary, and mandibular arches, but also in the nasal cavity, since the septum is located in the center of the nasal floor and rests on the median palatine suture. The purpose of this study the position of the nasal septum before and after surgical separation of the maxillary, was to identify and evaluate their influence on the movement of the jaw which remained attached. Fifty six cone beam computed tomography (CBCT) scanner acquired i-CAT Classic, with 0.3 mm voxel. Fourteen individuals submitted to SARPE in the preoperative and postoperative periods of 15, 60, and 180 days which were evaluated. Initially, postoperative images were visualized using multiplanar reformatting to identify which jaw, right or left, the nasal septum remained bound after the SARPE. In a second step, linear measurements in the images corresponding to the pre- and postoperative periods were performed. These measurements were performed in the axial immediately above the expander reformatting, standardized form for each patient, and consisted of the distance from a central reference line, passing the anterior nasal spine and the center of the incisive foramen, dividing the patient's right side and left to the canines and molars on the right and left. The intraobserver kappa index was > 0.9. To compare the differences between the means of two groups (side connected to the nasal septum and not connected to the nasal septum) a t test was used. In 78.6% of patients, the nasal septum remained attached to the left maxilla and 21.4% on right jaw. Regarding linear measurements, both in the region of canines as in the molar region, it was observed that, in the preoperative period, there was no difference between the right and left sides. After the SARPE, a statistically...

Avaliação da influência do septo nasal na expansão de maxila cirurgicamente assistida por meio de tomografia computadorizada de feixe cônico / Evaluation of the influence of the nasal septum in surgically assisted maxillary expansion using cone computed tomography

A expansão da maxila cirurgicamente assistida (EMCA) é um procedimento cirúrgico indicado para a correção da atresia maxilar em pacientes que já atingiram a maturação óssea. Os efeitos da EMCA são observados não só nos arcos dentários, maxilas e mandíbula, mas também na cavidade nasal, já que o septo nasal encontra-se localizado no centro do assoalho nasal, apoiado sobre a sutura palatina mediana. O objetivo deste estudo foi identificar a posição do septo nasal antes e após a separação cirúrgica das maxilas e avaliar sua influência na movimentação da maxila do lado que foi deslocado. Foram avaliadas 56 tomografias computadorizadas de feixe cônico (TCFC) adquiridas no tomográfo i-CAT Classic®, com voxel de 0,3mm, de 14 indivíduos submetidos à EMCA nos períodos préoperatório e pós-operatório de 15, 60 e 180 dias. Inicialmente, as imagens pósoperatórias foram visualizadas nas reformatações multiplanares, para identificar a qual maxila, direita ou esquerda, o septo nasal permaneceu ligado após a EMCA. Numa segunda etapa, foram realizadas medidas lineares nas imagens correspondentes aos períodos pré e pósoperatórios. Essas medidas foram realizadas na reformatação axial imediatamente acima do aparelho expansor, de forma padronizada para cada paciente, e consistiram da distância entre uma linha de referência central, que passava na espinha nasal anterior e no centro do forame incisivo, dividindo o paciente em lado direito e esquerdo, até os caninos e molares direitos e esquerdos. O índice kappa intraexaminador foi > 0,9. Para comparar as diferenças entre as médias dos dois grupos (lado ligado ao septo nasal e não ligado ao septo nasal) foi utilizado o teste t. Em 78,6% dos pacientes o septo nasal permaneceu ligado à maxila esquerda e em 21,4%, ligado à maxila direita. Em relação às medidas lineares, tanto na região de caninos como na região de molares, observouse que, no período pré-operatório, não havia diferença entre os lados direito e esquerdo...

The Surgically assisted rapid palatal expansion (SARPE) is a surgical procedure indicated for the correction of maxillary constriction in adult patients. The effects of EMCA are observed not only in dental, maxillary, and mandibular arches, but also in the nasal cavity, since the septum is located in the center of the nasal floor and rests on the median palatine suture. The purpose of this study the position of the nasal septum before and after surgical separation of the maxillary, was to identify and evaluate their influence on the movement of the jaw which remained attached. Fifty six cone beam computed tomography (CBCT) scanner acquired i-CAT Classic, with 0.3 mm voxel. Fourteen individuals submitted to SARPE in the preoperative and postoperative periods of 15, 60, and 180 days which were evaluated. Initially, postoperative images were visualized using multiplanar reformatting to identify which jaw, right or left, the nasal septum remained bound after the SARPE. In a second step, linear measurements in the images corresponding to the pre- and postoperative periods were performed. These measurements were performed in the axial immediately above the expander reformatting, standardized form for each patient, and consisted of the distance from a central reference line, passing the anterior nasal spine and the center of the incisive foramen, dividing the patient's right side and left to the canines and molars on the right and left. The intraobserver kappa index was > 0.9. To compare the differences between the means of two groups (side connected to the nasal septum and not connected to the nasal septum) a t test was used. In 78.6% of patients, the nasal septum remained attached to the left maxilla and 21.4% on right jaw. Regarding linear measurements, both in the region of canines as in the molar region, it was observed that, in the preoperative period, there was no difference between the right and left sides. After the SARPE, a statistically...

Órgano vomeronasal: estudio anatómico de prevalencia y su función / The vomeronasal organ: anatomic study of prevalence and its role

Introducción: El órgano vomeronasal (OVN) descrito por Jacobson en mamíferos distintos al ser humano, es una incógnita tanto en lo que se refiere a su localización así como a su función en la raza humana. Se considera como un vestigio del olfato, que en los animales mamíferos parece influir en los hábitos sexuales (feromonas) y sociales. Hasta la fecha han sido escasos los estudios concluyentes al respecto en humanos. Objetivo: Conocer la prevalencia del órgano vomeronasal en nuestras consultas. Material y método: Presentamos un estudio prospectivo de prevalencia de la frecuencia de aparición de dicho órgano en 150 sujetos distribuidos por edad y sexo, explorados por endoscopia nasosinusal rígida. Por otro lado, analizamos la influencia sobre la libido (normal-disminuida-aumentada) en el posoperatorio de 35 septoplastías, a los 15 días tras retirada de taponamiento nasal y a los 30 días y lo comparamos con un grupo de 40 pacientes intervenidos timpanoplastías. Resultados: Estudiados 150 sujetos, encontramos la presencia del órgano vomeronasal en el 39,33% (59), de los cuales el 72,88% (43) fue unilateral (23 derecha y 20 izquierda) y el 27,12% (16) bilateral. En 91 (60,67%) no hallamos dicha estructura. La libido de los 35 pacientes intervenidos de septoplastía estaba disminuida, a los 15 días, en el 77,14% (27) frente al 40% (16) de las timpanoplastías, normal en el 17,14% (6) frente al 50% (20) de las cirugías otológicas, y en 2 (5,7%) poseptoplastía había aumentado, frente al 10% (4) del otro grupo. A los 30 días, en el 77,14% (27) de las septoplastías se había normalizado frente al 90% (36) del grupo otológico, en 2 (5,71%) de la cirugía nasal continuaba disminuida frente al 10% (4) del grupo de las timpanoplastías y en 6 (17,14%) tras septoplastía había aumentado. A todos los pacientes se les aplicó el mismo test no normalizado. Conclusión: El órgano vomeronasal de Jacobson continúa siendo un gran desconocido. Es una estructura que, al parecer, no es constante, al menos a la exploración endoscópica nasosinusal. Es difícil valorar si la cirugía en sí misma o el trauma psicológico posquirúrgico son los que afectan la libido de los pacientes tras la cirugía.

Introduction: The vomeronasal organ (OVN) described by Jacobson in mammals other than humans is unknown both in terms of its location and its role in the human race. It is viewed as a vestige of smell, that mammals in the animal seems to influence the sexual habits (pheromone) and social. To date, few studies have been inconclusive on this in humans. Aim: To determine the prevalence of vomeronasal organ in our medical consultations. Materials and methods: We report a prospective prevalence study of the occurrence of such a body in 150 subjects distributed by age and sex explored by endoscopic sinus rigid. On the other hand, we analyze the effect on the libido (normally less-plus) in the postoperative 35 septoplasty, 15 days after the withdrawal of nasal pack and 30 days and compared with a group of 40 tympanoplasty surgery. Results: Studied 150 subjects, we found the presence of the vomeronasal organ in 39.33% (59), of which 72.88% (43) had unilateral (23 right and 20 left) and 27.12% (16) bilaterally. In 91 (60.67%) did not find such a structure. The libido of the 35 patients who underwent septoplasty was decreased at 15 days, at 77.14% (27) versus 40% (16) of tympanoplasty, normal in 17.14% (6) compared to 50% (20) of otologic surgery, and in 2 (5.7%) postseptoplasty had increased, compared to 10% (4) the other group. At 30 days, in 77.14% (27) of the septoplasty group the libido was normalized against 90% (36) in the otologic group. In 2 cases (5.71%) of nasal surgery group was still decreased versus 10% (4) of cases of the tympanoplasty group, and in 6 (17.14%) postseptoplasty was increased. All patients were administered the same test is not standardized. Conclusion: The vomeronasal organ of Jacobson remains the great unknown. It is a structure that apparently is not constant, at least in the endoscopic sinus exploration. With regard to their role, it is difficult to assess whether the psychological trauma after surgery or the surgery by itself is responsible of the libido changes.

Evaluation of the lateral wall of the nasal cavity in relation to septal deviation / Evaluación de la pared lateral de la cavidad nasal en relación con la desviación septal

The objective of this study was to evaluate the relationship between variations of the lateral wall of the nasal cavity and septal deviation (SD). Coronal and axial paranasal sinus CT images of 115 individuals (65 females, 50 males) were reviewed and the presence of pneumatisation and hypertrophy of the conchae was evaluated. Pneumatisation of the concha was classified as lamellar concha bullosa (LCB), bulbous concha bullosa (BCB), or extensive concha bullosa (ECB). If bulbous and extensive conchae and hypertrophic conchae were bilateral the side on which it was greatest was accepted as the dominant concha. The relationship between these variations and nasal septum deviation was also taken into account. Eighty-six (74.8 percent) of the 115 subjects had SD. Of these, 20 were not affected by the size of the middle nasal concha (MNC) or inferior nasal concha (INC). Thirty-four cases had dominant MNC, 20 had dominant INC, and 11 had both dominant MNC and dominant INC, and all of which had SD towards the opposite side. In one case there was SD towards the side in which the MNC was dominant. Our data indicate that coexistence of pneumatisation or hypertrophy of the conchae and SD was more common in adults compared to the results of similar studies conducted with a wide range of age groups, including children. Thus the presence of SD together with a large concha increases with age. A prospective study, which will include infants, will elucidate the relationship between conchae and SD.

El objetivo del estudio fue evaluar la relación existente entre las variaciones de la pared lateral de la cavidad nasal y la desviación septal. Se revisaron los senos paranasales en imágenes de TC de 115 individuos (65 mujeres, 50 varones) coronales y axiales y se evaluó en ellas la presencia de neumatización e hipertrofia de los conchas nasales. La neumatización de la concha fue clasificada como concha laminar bulosa (CLB), concha bulbosa bulosa (CBB), o concha extensa bulosa (ECB). Conchas nasales bulbosa y extensa y conchas hipertróficas eran bilaterales siendo el lado en que esta era más grande como la concha dominante. También se tuvo en consideración la relación entre estas variacio nes y la desviación del tabique nasal. Ochenta y seis (74,8 por ciento) de los 115 sujetos tenían desviación septal. De éstos, 20 no se vieron afectados por el tamaño de la concha nasal media (CNM) o concha nasal inferior (CNI). Treinta y cuatro de los casos tenía CNM dominante, 20 tenían CNI dominante, y 11 tenían tanto CNM dominante y CNI dominante, todos los cuales tenían desviación septal hacia el lado opuesto. En un caso hubo desviación septal hacia el lado en el que el CNM era dominante. Nuestros datos indican que la coexistencia de neumatización o hipertrofia de conchas nasales y la desviación septal es más común en adultos en comparación con los resultados de estudios similares realizados con una amplia gama de grupos etarios, incluidos los niños. Así, la presencia de desviación septal, junto con una gran concha aumenta con la edad. Un estudio prospectivo, que incluirá los bebés, aclarará la relación entre concha nasal y desviación septal.

Variações anatômicas do complexo ostiomeatal: achados tomográficos em 200 pacientes / Anatomical variants of the ostiomeatal complex: tomographic findings in 200 patients

OBJETIVO: O objetivo deste trabalho foi verificar a freqüência e os tipos de variações anatômicas do complexo ostiomeatal. MATERIAIS E MÉTODOS: Foram revisadas 200 tomografias computadorizadas de pacientes com suspeita clínica de sinusopatia. RESULTADOS: Observamos um ou mais tipos de variações anatômicas em 83,5 por cento dos pacientes, as mais freqüentes envolvendo o corneto médio (84 por cento) e o septo nasal (34 por cento). Outras variantes anatômicas comuns encontradas foram a presença de aeração do agger nasi e células etmoidais infra-orbitárias (células de Haller). CONCLUSÃO: As variações anatômicas do complexo ostiomeatal anterior são muito corriqueiras. As mais freqüentes envolvem o corneto médio e o septo nasal.

OBJECTIVE: The present study was aimed at evaluating the frequency and types of anatomical variants of the ostiomeatal complex. MATERIALS AND METHODS: Computed tomography studies of 200 patients evaluated for clinical suspicion of sinusopathy were reviewed. RESULTS: Two or more types of anatomical variants were observed in 83.5 percent of the patients. The most frequent anatomical variants involved the middle turbinate (84 percent) and the nasal septum (34 percent). Other common variants found were the presence of pneumatized agger nasi cells and infraorbital ethmoid cells (Haller cells). CONCLUSION: The prevalence of anatomical variants in the ostiomeatal complex is high, the most frequent ones involving the middle turbinate and the nasal septum.

Estudio morfológico comparativo de la nariz de animales de laboratorio / Morphological study of the nasal cavity and septum in laboratory animals

Se hizo comparación de la anatomía macroscópica e histológica del septum nasal de tres especímenes de perros, gatos, cobayos, conejos, ratas y ratones. Se describen las similitudes y las diferencias entre las porciones anterior, media y posterior en cada especie.

Contribuiçäo ao estudo anatômico e cirúrgico dos músculos da ponta nasal / Contribution to the anatomical and surgical study of muscles of the nasal tip

Os músculos depressor do septo e nasolabial foram dissecados a fresco, em 25 cadáveres (24 brancos e 1 näo branco; 23 homens e 2 mulheres). O autor estuda minuciosamente a anatomia e analisa a sua importância em rinoplastias estéticas. Os achados säo comparados aos da literatura pesquisada

Valoración clínico-funcional de las desviaciones rinoseptales / Value functional-clinical of rhinoseptal deviation

En el presente trabajo se estudiaron 117 personas, con edades que oscilaron entre los 5 y 65 años (74 masculinos y 43 femeninos). Ciento doce, presentaban desviación rinoseptal (desviación, obstrucción, impactación) y 5 eran normales. Se les estudió por medio de una valoración clínico-rinológica (incluidos los índices nasales antropométricos), un cuestionario de sintomatología respiratoria y rinomanometría. Se encontró índice nasal de leptorrino en todos los casos. Las áreas nasales más afectadas fueron la II y IV, observándose mayor alteración funcional de tipo estructural en el área II; las desviaciones en área IV mostraron un predominio de alteración funcional de tipo mucoso o bien fueron normales. Existe una relación directa entre la resistencia nasal y la sintomatología respiratoria, a mayor resistencia, mayor número e intensidade de síntomas