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Tortuosity: Measuring the Septum

Easy to Understand Summary:

Imagine you're trying to understand why some people's noses are a bit more zigzagged than straight. In 2011 a team of doctors, including Dr. Anil Shah, came up with a cool way to measure this. They use something called "tortuosity," which basically looks at how wavy the wall inside your nose is compared to a perfectly straight line. What they found is that older kids and grown-ups are more likely to have these wavy noses than little kids. This suggests that these nose bends, which some choose to correct with a rhinoplasty, might develop as you grow rather than being something you're born with.


Now, while Dr. Shah uses this innovative approach, other scientists turn to various other technological tools. They’ve got things like acoustic rhinometry and rhinomanometry, which are as sci-fi as they sound, and they help spot these bends in the nose by checking out how air flows through your nose. But these methods sometimes miss the mark unless you pair them up with some camera work like endoscopy or cool imaging techniques.


Technological advancements are constant, creating new ways to check how thick the nasal wall is after surgery, super-detailed CT scans, and even a special index made from fancy 3D scans that helps doctors get a clearer picture of what’s going on inside noses. This push towards using exciting new digital tools and precise measurements is all about making sure doctors really understand your nose’s anatomy and can give you the best care possible.

Advanced Reading:

Scholarly Level Content

Please note that the content of this article is written at a scholarly, medical level and may be difficult to understand if you are not familiar with medical terminology or advanced concepts in this area. We recommend using our glossary of key terms to aid in your understanding of this section of the article.

The article by Reitzen et al. (2011) introduces a unique approach to quantifying nasal septal deviation through a measure called "tortuosity," focusing on the ratio between the actual length of the septum and its ideal straight length. This methodology offers a direct and simplified measure to compare septal deviation across different age groups, demonstrating that older children and adults exhibit a higher frequency of deviation than younger children, which could suggest noncongenital etiology for most cases of nasal septal deviation.


Comparing this approach to others in the field reveals a diversity of methodologies for assessing and classifying nasal septal deviations:


Measurement Tools for Diagnosis: Aziz et al. (2014) conducted a systematic review identifying various diagnostic tools like acoustic rhinometry, rhinomanometry, and nasal spectral sound analysis as useful for identifying nasal septal deviation, particularly in the anterior region of the nasal cavity. However, they noted these tests, in isolation, lack sensitivity and specificity compared to endoscopy and imaging, underscoring the complexity and variability in measuring septal deviation.


Nasal Septum Measurement Device: Sooklal et al. (2013) described an easy-to-use device designed to measure nasal septal thickness post-surgery, providing a practical tool for clinical assessments. This innovation highlights the ongoing efforts to develop simple and effective techniques for evaluating septal deviations in a clinical setting.


Morphometric Analysis Using CT: Orhan et al. (2014) investigated the relationship between nasal septum deviation and maxillary sinus volume, utilizing CT images for a three-dimensional reconstruction to assess sinus volumes and septal deviation angles. This study exemplifies the use of advanced imaging techniques for a comprehensive evaluation of nasal anatomy and deviations.


CT-based Classification System: Lin et al. (2014) proposed a new classification system based on CT scans, quantifying deviations with measures like the line to curve ratio and deviation area. This method aimed to provide a more objective and detailed analysis of septal deviations, reflecting the trend towards leveraging digital imaging and analysis tools in rhinology research.


Nasal Septum Deviation Index (NSDI): Codari et al. (2016) introduced a septal deviation index based on CBCT data, demonstrating the potential of three-dimensional morphometric parameters in diagnosing nasal septal deviation. This index represents another step towards standardized, objective metrics for evaluating septal deviations.


The article by Reitzen et al. (2011) contributes to this diverse landscape by offering a simple yet effective method for comparing septal deviations across different ages, enriching the diagnostic toolkit available to clinicians and researchers. The evolving methodologies reflect a broader trend towards precision, objectivity, and comprehensiveness in diagnosing and classifying nasal septal deviations.

The video in this post has been transcribed using an automated service. Please forgive any typographic errors or other transcription flaws.

Dr. Shah:

Alright, so I'm gonna be explaining a scientific article I wrote and came up with this medical term and why you should care about it. So the medical term I came up with is called tortuosity, and that's kind of a fancy mathematical term. And we'll explain what this means. So essentially I was looking at deviated septum and a septum for those of you who don't know, is a piece of cartilage and bone that divides your nose ideally into two identical symmetrical halves. In reality you think this would be pretty easy to measure with a CT or MRI, but most of the time it's actually very difficult because the nose itself and the face have these subtle deviations throughout it and maybe the septum's going from the left to the right. And if you say, I'm gonna measure all the parts of the nose this way, I'm gonna measure all the parts of the nose on the right versus the left, they might even out and it might look like the nose is straight.


So there's really, it's kind of more difficult than you think from a mathematical standpoint. So just using basic algebraic techniques wasn't really gonna cut it. So myself and my co-authors came up with this new mathematical term called tortuosity or this new, new term for describing septum. And what we did is we actually measured the length of the septum versus the actual length, the ideal length versus the actual length. And when the septum would cross over and go back and forth, we would come up with this torturous number, which is kind of almost like a calculus kind of figure. And we did this on our CTs and MRIs. And the reason this was helpful is that oftentimes an area of frustration for me and for many of my patients is they'll get a CT or MRI the doctor will say they do or do not have a deviated septum. And essentially there wasn't really a tool to measure that. So again, if you're into math I can dive into this a little deeper in the article. But if you're not into math, I’ll just let you know that there's different ways of measuring how you can calculate a deviated septum.

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