Case Report And Clinical Analysis Of Postural Skewing Of The Nasal Septum After Septal Deviation Correction

Objective:Through evaluating the patients with inferior lateral nasal obstruction in the lateral decubitus after septal deviation correction,to observe and analyze postural skewing of the nasal septum(PSNS),a rare influencing factor of nasal obstruction after septal deviation correction.Methods:Patients who visited the outpatient department of our hospital from January 2021 to February 2023 with the chief complaint of "inferior lateral nasal obstruction in the lateral decubitus" after septal deviation correction were selected.Their medical history was screened according to the inclusion and exclusion criteria.The selected patients were evaluated subjectively and objectively in their sitting position,left lateral position,and right lateral position,respectively.Subjective evaluation: The Chinese version of the nasal obstruction symptom evaluation(NOSE)and the visual analogue scale(VAS)were used to confirm the patients’ recent nasal obstruction symptoms.The alteration in nasal obstruction sensation was also recorded when the patient’s position changed.Objective evaluation:acoustic rhinometry(AR)and rhinomanometry(RMM)were used to reflect changes in nasal cavity volume and resistance,respectively.Under nasal endoscopy and imaging examination,the anatomical variation of the nasal cavity and postural skewing of the nasal septum were recorded,and possible factors related to nasal obstruction were discovered.In addition to computed tomography(CT),magnetic resonance imaging(MRI)was performed for patients with highly suspected PSNS.Results:In this study,a total of 10 patients with symptoms of inferior lateral nasal obstruction in the lateral decubitus after septal deviation correction were selected.Each patient was confirmed to have these symptoms by means of the NOSE score.Among them,3 patients with PSNS were observed,including 1 patient admitted for surgery;the other 7 patients had non-PSNS.1.Endoscopic evaluation of the patients with PSNS in the lateral decubitus showed that the nasal septum shifted and deformed on the downward side,which blocked the posterior nasal view.2.MRI could clearly distinguish the nasal septal cartilage and mucosa,and found the loss of nasal septal cartilage and the skewing of the missing part to the low position in PSNS patients.3.The VAS score of nasal ventilation can quantify the nasal obstruction symptoms of patients in different positions.Acoustic rhinometry can reflect the effect of PSNS on nasal valve volume;rhinomanometry and acoustic rhinometry,lack of stable correlation with the nasal ventilation VAS score.4.Both the symptoms of inferior lateral nasal obstruction in the lateral decubitus and the manifestations of the nasal septum skewed and deformed on the downward side were improved through stabilizing the nasal septum utilizing the bone of the frontal wall of the maxilla.5.From the endoscopy and imaging examination of non-PSNS patients,a variety of possible factors causing the symptoms of inferior lateral nasal obstruction in the lateral decubitus were screened,including turbinate hypertrophy,bullous turbinate,nasal adhesion,nasal septal deviation,nasal meatus stenosis,nasal valve stenosis,etc.Conclusion:1.For patients with the chief complaint of "inferior lateral nasal obstruction in the lateral decubitus" after septal deviation correction,when screening and diagnosing the related factors of postoperative nasal obstruction,we should thoroughly evaluate and take the possibility of PSNS into consideration to avoid the failure of second surgery.2.Nasal endoscopy,MRI examination,and the VAS score of nasal ventilation are recommended as the main means to diagnose PSNS,understand the residual condition of cartilage,and evaluate the change in nasal obstruction.3.While correcting the nasal septal deviation,the bone and cartilage of the nasal septum should be preserved as much as possible to prevent postoperative PSNS.4.Autologous bone and cartilage may be used to treat PSNS patients in a bid to rebuild missing cartilage structure,secure the nasal septum,and alleviate the symptoms of inferior lateral nasal obstruction in the lateral decubitus.