Skip to main content
SpringerLink
Log in

Asymmetry of inferior turbinate in patients with nasal septum deviation and its significance for nasal ventilation surgery

  • Rhinology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

To investigate the asymmetry of the inferior turbinate (IT) in patients with nasal septum deviation (NSD).

Methods

The paranasal sinus computed tomography (CT) of 100 patients with NSD were retrospectively investigated from February 2018 to December 2019. The thickness of IT, IT mucosa and IT bone, the distance between the IT and the midline were measured on both the concave and convex sides, and which correlation with NSD was analyzed.

Results

The widths of the IT, IT bone and IT medial mucosa on the concave side were larger than those on the convex side (all P < 0.05). The distance from the IT and IT bone to the midline on the concave side was smaller than those on the convex side (P < 0.05, respectively). The degree of NSD had a negative correlation with the widths of the IT and IT bone on the convex side, and the distance between the IT and the midline on the concave side; and a positive correlation with the distance from IT and IT bone to the midline on the convex side, and IT mucosa thickness on the concave side (all P < 0.05).

Conclusion

The asymmetric IT width is mainly caused by both hypertrophies of the IT mucosa on the concave side and atrophy of the IT bone on the convex side. Therefore, during the surgery of nasal ventilation reconstruction, the IT on the convex side are suggested to be protected from intervention. In contrast, it is necessary to lateralize the IT bone and reduce the IT submucosal tissue on the concave side. However, routine excision of the IT bone is not recommended.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Koo SK, Kim JD, Moon JS, Jung SH, Lee SH (2017) The incidence of concha bullosa, unusual anatomic variation and its relationship to nasal septal deviation: a retrospective radiologic study. Auris Nasus Larynx 44:561–570. https://doi.org/10.1016/j.anl.2017.01.003

    Article  PubMed  Google Scholar 

  2. Liu J, Yan Z, Zhang Z, Wang N (2020) Septoplasty alone is not suitable for the most of structural nasal obstruction. World J Otorhinolaryngol Head Neck Surg. https://doi.org/10.1016/j.wjorl.2020.05.007

    Article  PubMed  PubMed Central  Google Scholar 

  3. Tjahjono R, Alvarado R, Kalish L et al (2019) Health impairment from nasal airway obstruction and changes in health utility values from septorhinoplasty. JAMA Facial Plast Surg 21(2):146–151. https://doi.org/10.1001/jamafacial.2018.1368

    Article  PubMed  Google Scholar 

  4. Yamasaki A, Levesque PA, Bleier BS et al (2019) Improvement in nasal obstruction and quality of life after septorhinoplasty and turbinate surgery. Laryngoscope 129(7):1554–1560. https://doi.org/10.1002/lary.27859

    Article  PubMed  Google Scholar 

  5. Han D, Zhang L (2011) Nasal cavity ventilation expansion techniques. Acta Otolaryngol 131:1244–1248. https://doi.org/10.3109/00016489.2011.615760

    Article  PubMed  Google Scholar 

  6. Most SP, Rudy SF (2017) Septoplasty: basic and advanced techniques. Facial Plast Surg Clin North Am 25:161–169. https://doi.org/10.1016/j.fsc.2016.12.002

    Article  PubMed  Google Scholar 

  7. van Egmond MMHT, Rovers MM, Tillema AHJ, van Neerbeek N (2018) Septoplasty for nasal obstruction due to a deviated nasal septum in adults: a systematic review. Rhinology 56:195–208. https://doi.org/10.4193/Rhin18.016

    Article  PubMed  Google Scholar 

  8. van Egmond MMHT, Rovers MM, Hannink G, Hendriks CTM, van Heerbeek N (2019) Septoplasty with or without concurrent turbinate surgery versus non-surgical management for nasal obstruction in adults with a deviated septum: a pragmatic, randomised controlled trial. Lancet 394:314–321. https://doi.org/10.1016/S0140-6736(19)30354-X

    Article  PubMed  Google Scholar 

  9. Moore M, Eccles R (2011) Objective evidence for the efficacy of surgical management of the deviated septum as a treatment for chronic nasal obstruction: a systematic review. Clin Otolaryngol 36:106–113. https://doi.org/10.1111/j.1749-4486.2011.02279.x

    Article  CAS  PubMed  Google Scholar 

  10. Becker SS, Dobratz EJ, Stowell N, Barker D, Park SS (2008) Revision septoplasty: review of sources of persistent nasal obstruction. Am J Rhinol 22:440–444. https://doi.org/10.2500/ajr.2008.22.3200

    Article  PubMed  Google Scholar 

  11. Singh A, Maniskas SA, Bruckman KC, Steinbacher DM (2020) Rhinoplasty using three-dimensional analysis and simulation. Plast Reconstr Surg 145(4):944–946. https://doi.org/10.1097/PRS.0000000000006687

    Article  CAS  PubMed  Google Scholar 

  12. Ural A, Kanmaz A, Inançli HM, Imamoğlu M (2010) Association of inferior turbinate enlargement, concha bullosa and nasal valve collapse with the convexity of septal deviation. Acta Otolaryngol 130:271–274. https://doi.org/10.3109/00016480903036263

    Article  PubMed  Google Scholar 

  13. Demir D, Asil K, Güven M, Kayabaşoğlu G, Yılmaz MS (2015) Assessment of the correlation between nasal septal deviation and compensatory hypertrophy of the middle turbinate. Eur Arch Otorhinolaryngol 272:2847–2851. https://doi.org/10.1007/s00405-014-3387-6

    Article  PubMed  Google Scholar 

  14. Demir D, Asil K, Güven M, Erkorkmaz Ü (2016) Does septoplasty change the dimensions of compensatory hypertrophy of the middle turbinate? J Laryngol Otol 130:554–559. https://doi.org/10.1017/S0022215116001055

    Article  CAS  PubMed  Google Scholar 

  15. Egeli E, Demirci L, Yazýcý B, Harputluoglu U (2004) Evaluation of the inferior turbinate in patients with deviated nasal septum by using computed tomography. Laryngoscope 114:113–117

    Article  Google Scholar 

  16. Akoğlu E, Karazincir S, Balci A, Okuyucu S, Sumbas H, Dağli AS (2007) Evaluation of the turbinate hypertrophy by computed tomography in patients with deviated nasal septum. Otolaryngol Head Neck Surg 136:380–384

    Article  Google Scholar 

  17. Korkut AY, Islim F, Gulseven Ciftci S, Dogan R, Gedikli O et al (2012) Evaluation of inferior turbinate hypertrophy in patients with congenital and traumatic nasal septum deviation. J Laryngol Otol 126:784–788. https://doi.org/10.1017/S0022215112001260

    Article  CAS  PubMed  Google Scholar 

  18. Orhan I, Aydın S, Ormeci T, Yılmaz F (2014) A radiological analysis of inferior turbinate in patients with deviated nasal septum by using computed tomography. Am J Rhinol Allergy 28:e68-72. https://doi.org/10.2500/ajra.2014.28.4007

    Article  PubMed  Google Scholar 

  19. Becker DG, Ransom E, Guy C, Bloom J (2020) Surgical treatment of nasal obstruction in rhinoplasty. Aesthet Surg J 30(3):347–380. https://doi.org/10.1177/1090820X10373357

    Article  Google Scholar 

  20. Devseren NO, Ecevit MC, Erdag TK, Ceryan K (2011) A randomized clinical study: outcome of submucous resection of compensatory inferior turbinate during septoplasty. Rhinology 49(1):53–57. https://doi.org/10.4193/Rhino10.006

    Article  PubMed  Google Scholar 

  21. Jun BC, Kim SW, Kim SW, Cho JH, Park YJ, Yoon HR (2009) Is turbinate surgery necessary when performing a septoplasty? Eur Arch Otorhinolaryngol 266(7):975–980. https://doi.org/10.1007/s00405-008-0855-x

    Article  PubMed  Google Scholar 

  22. Samarei R, Mabarian S (2020) A randomised trial comparing the subjective outcomes following septoplasty with or without inferior turbinoplasty. Eur Ann Otorhinolaryngol Head Neck Dis 137(4):277–283. https://doi.org/10.1016/j.anorl.2020.01.024

    Article  CAS  PubMed  Google Scholar 

  23. Whyte A, Boeddinghaus R (2020) Imaging of adult nasal obstruction. Clin Radiol 75(9):688–704. https://doi.org/10.1016/j.crad.2019.07.027

    Article  CAS  PubMed  Google Scholar 

  24. Lund VJ, Stammberger H, Fokkens WJ, Beale T, Bernal-Sprekelsen M, Eloy P et al (2014) European position paper on the anatomical terminology of the internal nose and paranasal sinuses. Rhinology 24:1–34

    PubMed  Google Scholar 

  25. Wright L, Grunzweig KA, Totonchi A (2020) Nasal obstruction and rhinoplasty: a focused literature review. Aesthetic Plast Surg 44(5):1658–1669. https://doi.org/10.1007/s00266-020-01710-5

    Article  PubMed  Google Scholar 

  26. San T, Muluk NB, Saylisoy S, Acar M, Cingi C (2014) Nasal septal body and inferior turbinate sizes differ in subjects grouped by sex and age. Rhinology 52(3):231–237. https://doi.org/10.4193/Rhin13.138

    Article  CAS  PubMed  Google Scholar 

  27. Williams R, Patel V, Chen YF, Tangbumrungtham N, Thamboo A, Most SP (2019) The upper airway nasal complex: structural contribution to persistent nasal obstruction. Otolaryngol Head Neck Surg 161:171–177. https://doi.org/10.1177/0194599819838262

    Article  PubMed  Google Scholar 

  28. Unadkat S, Pendolino AL, Joshi A, Bhalla R, Woolford T, D’Souza A et al (2020) A national survey of functional septorhinoplasty surgery performed in the United Kingdom: a clinician end-user questionnaire to assess current practice and help inform future practice. Eur Arch Otorhinolaryngol 277:475–482. https://doi.org/10.1007/s00405-019-05722-z

    Article  PubMed  Google Scholar 

  29. Janovic N, Janovic A, Milicic B, Djuric M (2019) Is computed tomography imaging of deviated nasal septum justified for obstruction confirmation? Ear Nose Throat J. https://doi.org/10.1177/0145561319871533

    Article  PubMed  Google Scholar 

  30. Han JK, Stringer SP, Rosenfeld RM, Archer SM, Baker DP, Brown SM et al (2015) Clinical consensus statement: septoplasty with or without inferior turbinate reduction. Otolaryngol Head Neck Surg 153:708–720. https://doi.org/10.1177/0194599815606435

    Article  PubMed  Google Scholar 

  31. Sommer F, Hoffmann TK (2019) Septoplasty-a surgical or political challenge? Lancet 394:276–278. https://doi.org/10.1016/S0140-6736(19)31241-3

    Article  PubMed  Google Scholar 

  32. Hsu DW, Suh JD (2018) Anatomy and physiology of nasal obstruction. Otolaryngol Clin North Am 51(5):853–865. https://doi.org/10.1016/j.otc.2018.05.001

    Article  PubMed  Google Scholar 

Download references

Funding

The general work was supported by the Capital Medical University Student Research Innovation Project (No. XSKY2020158) and the Natural Science Foundation of Beijing Chaoyang Hospital (CYYPY201917).

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing, 100020, China

    Jinfeng Liu, Zhanfeng Yan & Ningyu Wang

  2. Department of Otorhinolaryngology, Beijing Huairou Hospital of University of Chinese Academy of Sciences, Beijing, 101400, China

    Zhuoming Qian

  3. Department of Otorhinolaryngology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China

    Zhanfeng Yan

  4. 7 Medical Students of Long Schooling Class 3, The Third Clinical Medical School, Capital Medical University, Beijing, 100020, China

    Xuwen Yang

Authors
  1. Jinfeng Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zhuoming Qian
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zhanfeng Yan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xuwen Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ningyu Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jinfeng Liu.

Ethics declarations

Conflict of interest

The authors have no relevant competing interests to declare in relation to this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Liu, J., Qian, Z., Yan, Z. et al. Asymmetry of inferior turbinate in patients with nasal septum deviation and its significance for nasal ventilation surgery. Eur Arch Otorhinolaryngol 279, 2423–2431 (2022). https://doi.org/10.1007/s00405-021-07012-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-021-07012-z

Keywords

Search

Navigation