The Clinical Study On The Relationship Of Nasal Septum And Anatomical Variation Of Ostiomeatal Complex With Chronic Rhinosinusitis

ObjectiveMulti-slice spiral thin-section CT scan was employed, in combination with coronal imaging,axial imaging and sagittal imaging, to investigate the anatomic structure and anatomical variation of nasal septum and ostiomeatal complex (OMC) in patients with sinusitis and normal control group, respectively, and to discuss the relationship of nasal septum and anatomical variation of ostiomeatal complex with Chronic sinusitisMethod1.100cases of patients with sinusitis, who were definitely diagnosed by our hospital from July2009to July2011, were selected as sinusitis group and100non-sinusitis patients formed the control group (non-sinusitis group). The clinical information of both groups was collected for study. Patients with "S-shaped" nasal septal deviation were exclusive from both groups.2. Applying sinus coronal, axial and sagittal CT scan and nasal endoscopy to take satatistics the location,direction, extent of deviated nasal septum and anatomical structure and its variability of the ostiomeatal complex in sinusitis group and normal control group. To take statistics with all of above,as well as analysis of the relationship between with chronic sinusitis.Results1. The difference in the location and degree of nasal septal deviation between sinusitis group and control group was statistically significant(P<0.05). High and severe deflection of nasal septum have close relationship with chronic sinusitis.2. The difference between the frontal sinusitis and anterior ethmoid sinusitis in upper septal deviation and lower septal deviation of nasal septum is statistically significant (P<0.05). The upper septal deviation of nasal septum induces frontal sinusitis and anterior ethmoid sinusitis more easily.3. The difference in exposure risks for nasal septal deviation induced sinusitis between two different sides of sinus was statistically insignificant(P>0.05), namely of the incidence of sinusitis on both sides of nasal septum deviation without significant difference.4. Regarding to upper nasal septal deflection, the exposure risks for homolateral or bilateral OMC anatomical variation between sinusitis group and control group were significantly different(P<0.05); regarding to lower nasal septal deflection, the risks for bilateral OMC anatomical variation between sinusitis group and control group were significantly different(P<0.05), while difference in homolateral variation between the two groups was insignificant(P>0.05). Nasal septum deviation especially high deviation of nasal septum on both sides of the OMC anatomic variation exists difference, the contralateral deviation of nasal septum is more susceptible to OMC anatomic variations, and are related to the occurrence of CRS.5. The anatomical variation of OMC was as follows:from the statistic comparison, sinusitis group was significantly different from control group, with respect to middle concha bullosa, uncinate process deviation, uncinate process hypertrophy, agger nasi cells and Haller cells(P<0.05); in contrast, sinusitis group was insignificantly different from control group, with respect to middle concha reverse deviation, uncinate process bullosa, ethmoid air cells(P>0.05). The anatomic variations of ostiomeatal complex in middle concha bullosa, uncinate process deviation, uncinate process hypertrophy, agger nasi cell and Haller cell have close relationship with CRS.Conclusion1. Through coronal, axial and sagittal imaging, the location, properties, anatomical variation, range, degree of the lesion, as well as the possible complication during surgery, were accurately assessed, in particular, the anatomical variation of OMC was clearly revealed, and thus providing important reference for the selection of appropriate functional endoscopic sinus surgery, and ensuring the success rate.2. As nasal septal deviation, especially the upper saptal deflection, and anatomical variation of OMC played an important role on pathogenesis of chronic sinusitis, therefore, the treatment of chronic sinusitis required comprehensive concerns, i.e. while treating sinus mucous inflammation, nasal septal deviation and anatomical variation of OMC should be cleared at the same time.