International Journal of Head and Neck Surgery

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VOLUME 5 , ISSUE 1 ( January-April, 2014 ) > List of Articles


Criteria for Defining ‘Severe Septal Deviation’

Rahil Muzaffar, Owais Mattoo, Raja Salman Khurshid, Shafqat Islam

Citation Information : Muzaffar R, Mattoo O, Khurshid RS, Islam S. Criteria for Defining ‘Severe Septal Deviation’. Int J Head Neck Surg 2014; 5 (1):6-8.

DOI: 10.5005/jp-journals-10001-1170

Published Online: 01-06-2015

Copyright Statement:  Copyright © 2014; The Author(s).



Criteria for defining ‘severe septal deviation’ and to describe the clinical profile of the same.


Retrospective study.

Materials and methods

Hundred patients who were diagnosed with severe DNS and treated with extracorporeal septoplasty (ECSP) from September 2010 to December 2012, were retrospectively evaluated for this study. A review of their clinical charts formed the basis of this study.


In this study, majority of patients (96%) had nasal obstruction as their prime symptom followed by postnasal discharge in 60% cases, headache in 40% cases and anterior nasal discharge in 30% cases. External nasal deformity was reported by 22 patients. Snoring was seen in 24% of patients with same percentage complaining of altered sense of smell and throat discomfort. Epistaxis, sneezing and facial pain were seen in 14% patients. Epiphora was complained by only 8% of patients.

In this study, nasal endoscopy/anterior rhinoscopy was used to type the septal deformity. The commonest septal deviation was C-shaped cephalocaudal (48%), followed by S-shaped cephalocaudal (18%), C-shaped AP (16%), S-shaped AP (12%) and sharp septal deviation/angulation in 6% cases.

All but three patients (6%) had deviated nasal septum involving multiple Cottle's areas. These three patients had sharp septal angulation involving Cottle's area 2 only.

In this study, most common region involving DNS was area 1 + 2 + 3 (48%) followed by area 2 + 4 + 5 (28%) and 1 + 2 + 3 + 4 (18%).

Area 2 was invariably involved in 100% of cases.

NOSE (nasal obstruction symptom evaluation) scores.

Preoperatively, mean NOSE score was 67.60 ± 5.26 (65.34-72.86).

NSS (nasal symptoms score):

– Preoperatively, mean NSS was –5.08 ± 0.38 (–5.46-–4.70).


A septal deviation is regarded as ‘severe’ if patient satisfies all of the below-mentioned criteria:

– Preoperatively, mean NOSE score should be 65.34 or more.

Preoperatively, mean NSS should be –4.70 or more negative.

The septal deviation must cause significant obstruction to Cottle's area 2 or nasal valve area.

Patients of severe septal deviation report significantly higher rates of snoring (24% in our study) and PND (60% in our study) when compared with mild/moderate cases.

All severe septal deviations display significant obstruction of Cottle's area 2/nasal valve area and it is thus concluded that a severe septal deviation must cause significant obstruction of area 2/nasal valve.

How to cite this article

Mattoo O, Muzaffar R, Khurshid RS, Islam S. Criteria for Defining ‘Severe Septal Deviation’. Int J Head Neck Surg 2014;5(1):6-8.

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