Clinical Study On The Relationship Between Septal Deviation And Chronic Rhinosinusitis And OMC Anatomical Variation

BackgroundChronic rhinosinusitis(CRS)is a Chronic inflammatory disease with a course of more than 12 weeks and lesions affecting the nasal cavity and sinuses.It has different incidence in different regions,seasons and age groups.Although CRS is not a fatal disease,most patients are affected by both physical and psychological factors due to the long course of the disease,its tendency to relapse,and its chronic delay.At the same time,continuous drug or surgical intervention also increases their economic burden.At present,the factors leading to the onset of CRS are relatively complex,among which septum deviation and Ostiomeatal complex(OMC)obstruction are the most common.Understanding the relationship between them can guide clinical treatment more specifically.ObjectiveAnalyze the clinical features of CRS in patients with nasal septum deviation and the anatomical features of OMC area on both sides of patients with non-CRS nasal septal deviation,and explore their correlation with sinusitis.MethodA retrospective analysis was performed on 200 patients diagnosed with nasal septum deviation who were admitted to the department of otolaryngology of The First Clinical College of Xinxiang Medical University from December 2017 to July 2019,and they were divided into CRS group and non-CRS group according to whether sinusitis occurred or not.All the CT images of the sinuses were collected,and the multi-planar reconstruction(MPR)was used for measurement and observation.Combined with the endoscopic examination of the nose,the position,direction,degree and OMC anatomical variation of the septum deviation in the two groups were counted,and the incidence of the sinusitis on both sides of the wide and narrow was statistically analyzed.The incidence of sinusitis in the CRS group was evaluated using the Lund Mackay CT scoring system,and the composition and severity of the sinusitis in the broad and narrow sides were compared.Combined with the nasal endoscopic examination and the CT imaging findings after multi-plane reconstruction,the anatomical variation and incidence of OMC on both sides of the nasal cavity in the non-CRS group at different deviated positions were analyzed,and the difference characteristics of the anatomical variation of OMC on both sides of the deviated nasal septum and its influence on the incidence of sinusitis were discussed.Result1.There was no statistically significant difference in gender and age between the CRS group and the non-CRS group(P>0.05).2.The ratio of nasal septum deviation degree and position was statistically significant between the two groups(The Chi-square values were 7.114 and 6.328 respectively,P<0.05),while the deviation direction was not statistically significant between the two groups(The chi-square value was 0.983,P>0.05).3.The CT score of Lund-Mackay sinus in the narrow nasal cavity was higher than that in the wide nasal cavity in the CRS group,and the difference between the two nasal cavities was statistically significant(χ~2=24.715,P<0.01).The incidence of anterior ethmoid sinus and frontal sinus is higher when the nasal septum is in high deviation than in low deviation.4.In the non-CRS group,the OMC variation rate of the nasal septum deviated from the wide side of the nasal cavity was higher than that of the narrow side,and the proportion of vesicular hypertrophy was the highest.Unequal hypertrophy,sieve bubble hypertrophy,and middle turbinate reverse tensile variability were statistically different in both sides of the nasal cavity(P<0.05).The variability of vesicular middle turbinate,middle turbinate hypertrophy,and middle turbinate compression in both nasal cavities There was a significant statistical difference between the comparisons(P<0.01);while the variation rates of Haller air chamber,Onodi air chamber and Agger air chamber were not statistically significant in both nasal cavities(P>0.05).5.In the non-CRS group,the variability of middle turbinate hypertrophy,vesicular hypertrophy,middle turbinate retrotension,blistered middle turbinate and Agger air chamber were all higher than that of low deflection(P<0.05);The variability of turbinate compression,Haller’s air chamber and Onodi’s air chamber were compared when the nasal septum was high and low,and the difference was not statistically significant(P>0.05).Conclusions1.The composition of CRS is higher in high-deflection and severe deflection of the nasal septum,and the composition ratio of narrow-sided sinusitis is significantly higher than that of the wide-side.2.The incidence rate of OMC variation in different deviated positions and different nasal passages is different,which may be caused by compensatory developmental abnormalities of OMC structure after nasal cavity broadening,which can cause obstructive changes in the ipisional sinus.Therefore,surgery should be performed to correct the deviated bone in nasal septum and at the same time timely intervene and correct the deviated OMC structure.