Morpometric analysis of os ethmoidale and concha nasalis inferior in computerized tomography of persons with nasal septum deviation

Aim: In our study, we aimed to make morphometric measurements of the concha nasalis inferior and os ethmoidale in people with nasal septum deviation, to evaluate whether there is a relationship between the direction of nasal septum deviation and the severity of deviation, to contribute to clinical follow-up, surgical decision-making processes and to predict possible surgical complications. Material and Methods: Our study was conducted by the Department of Radiology of patients aged 18 and over who applied to Aydın Adnan Menderes University Practice and Research Hospital for various reasons between 1 June 2019 and 31 May 2021, after receiving approval from the Non-Interventional Clinical Research Ethics Committee of Aydın Adnan Menderes University Faculty of Medicine. It was carried out by retrospectively examining the paranasal sinus computed tomography images taken. Participants were aged 18 years and over, without a history of previous head trauma, without a history of paranasal sinus surgery, without a history of past or current disease in the ethmoid roof, without a congenital facial anomaly or known chromosomal anomaly, without a sinonasal tumor or dense sinonasal polyposis, and without a diagnosis of acute rhinosinusitis cases were included. In addition, images with artifacts that prevented measurement in the measurement area were not included in the study. Results: Our study consisted of a total of 304 cases, 158 males and 146 females. The age of the patients was found to be between 18 and 86, and the average age was 39.19±14.24. Nasal septum deviation was detected in 78% of the cases. No nasal septum deviation was detected in 15.2% of men and 27.4% of women. Women without nasal septum deviation were twice as likely as men without deviation. Deviation to the right was detected in 38% of the patients, deviation to the left in 40%, and no nasal septum deviation was detected in 22%, and left deviation was found more frequently, consistent with the literature. The depth of the left lamina cribrosa was found to be lower in cases with mild nasal septum deviation than in those with severe deviation. Lamina cribrosa depth was most frequently found to be Keros type 2. It was found that the right concha nasalis inferior medial mucosa thickness was less on the ipsilateral side and more on the contralateral side. Left concha nasalis inferior bone thickness was found to be statistically significantly higher on the contralateral side compared to the ipsilateral side. Left concha nasalis inferior bone thickness was found to be statistically significantly higher in patients without deviation than in patients with deviation to the left side. The right concha nasalis inferior attachment angle was found to be higher in cases with moderate septum deviation than in cases with mild and severe septum deviation. It was determined that as the lamina cribrosa depth increased, the medial foveal angle narrowed. The left medial foveal angle was found to be statistically significantly higher in women than in men. On the right side, the medial foveal angle was measured higher in women, but no statistical significance was determined based on gender. Conclusion: Before sinus surgery, it is important for the surgeon to analyze the patient's radiological examinations correctly and to know the anatomy of these regions and their neighborhoods well in reducing possible complications. In our study, it was determined that nasal septum deviation caused morphometric changes in the concha nasalis inferior and os ethmoidale in patients. Studies conducted with larger sample groups are needed to contribute to the literature. Keywords: Nasal septum deviation, concha nasalis inferior, ethmoid roof, lamina cribrosa depth, computed tomography