Nasal septal anatomical variations among Saudi population and their possible coincidence with sinusitis: a computed tomography scan study

Abstract

The nasal septum is a crucial supporting factor for the nasal cavity and may develop several anatomical variants including septal deviation, spur and pneumatization. These variants could be associated with a higher incidence of sinusitis due to structural and functional alterations. So, the aim of this study was to assess the prevalence of nasal septal deviation (NSD), nasal septal spur (NSS) and nasal septal pneumatization (NSP) among the Saudi adult population and their links with the incidence of sinusitis by using computed tomography (CT). A retrospective study was achieved over a twenty-two months period on 681 adult Saudi subjects (420 males and 261 females) aged 20 years or older, referred for coronal CT evaluation of the paranasal sinuses. NSD and NSS were significantly more prevalent in males than females (80.0% vs. 67.4% respectively for NSD, and 34.5% vs. 24.9% respectively for NSS), while there was no statistical difference in frequency of NSP regarding gender (P=0.670). The incidence of sinusitis was significantly higher in presence of NSD and/or NSS (P<0.001 for both). On the contrary, NSP was not associated with a significant increase in the prevalence of sinusitis (P=0.131). In conclusion, NSD and NSS are more prevalent in males than females among the Saudi population with no statistical difference between both genders regarding the presence of septal pneumatization. Furthermore, sinusitis is more prevalent with the occurrence of NSD and NSS, and not related to the incidence of NSP.

Keywords: Computed tomography; Nasal septal variation; Saudi population; Sinusitis.

Fig. 1

Coronal CT images demonstrating measurement procedures of nasal septal angle showing point A is the maxillary crest, point B is the junction point of the perpendicular and the cribriform plate of ethmoid bone, and point C is the most prominent point of the deviated septum. (A) Normal nasal septum. (B) Right-sided NSD. (C) S-shaped NSD. CT, computed tomography; NSD, nasal septal deviation.

Fig. 2

The degree of NSD in male and female subjects. Values are presented as means with the minimal and maximal values. Statistical analysis was performed by unpaired Student’s t-test. NSD, nasal septal deviation.

Fig. 3

Coronal CT images. (A) Left-sided NSD (arrow) with bilateral normal mucosa of both maxillary (asterisks) and ethmoid (arrowheads) sinuses. (B) Left-sided NSD (arrow) with mild sinusitis of both maxillary sinuses (asterisks). (C) S-shaped NSD (arrows) with bilateral normal mucosa of both maxillary (asterisks) and ethmoid (arrowheads) sinuses. (D) S-shaped NSD (arrows) with bilateral maxillary (asterisks) and ethmoid (arrowheads) sinusitis. (E) Left-sided NSD with ipsilateral NSS (arrow), and normal mucosa of both maxillary (asterisks) and ethmoid (arrowheads) sinuses. (F) Centralized nasal septum with left NSS (arrow) and mucosal thickening of both maxillary sinuses (asterisks). (G) Pneumatization (arrow) of a centralized nasal septum with normal mucosa of both maxillary (asterisks) and ethmoid (arrowheads) sinuses. (H) Pneumatization (arrow) of a centralized nasal septum with left maxillary sinusitis (asterisk). CT, computed tomography; NSD, nasal septal deviation; NSS, nasal septal spur.

Fig. 4

Percentages of incidence of sinusitis according to the severity of NSD. (B) Percentages of incidence of NSS according to the severity of NSD. (C) Percentages of incidence of NSP according to the severity of NSD. NSD, nasal septal deviation; NSS, nasal septal spur.