鼻腔框架结构畸形影响鼻腔结构及鼻窦气化的CT研究进展

Advances in CT research on the impact of nasal framework deformation on nasal cavity structure and sinus pneumatization

摘要

鼻腔作为呼吸道的门户,藉由其与外界进行通气来实现过滤空气颗粒、嗅觉及加温湿润空气等重要生理功能。鼻腔框架结构畸形是指影响鼻腔气流作为主要特征的鼻腔骨性及软骨结构的异常改变,鼻窦CT作为鼻腔框架结构畸形的主要诊断工具,其三维重建后在临床上被运用于观测鼻腔鼻窦解剖结构和鼻腔气流动力学。目前越来越多CT研究报道鼻腔框架结构畸形与鼻腔鼻窦解剖结构的改变密切相关,并且参与慢性鼻窦炎、隐匿性鼻窦综合征、阻塞性睡眠呼吸暂停低通气综合征、单侧慢性泪囊炎及上气道咳嗽综合征等疾病的进展及预后,这表明鼻腔框架结构畸形在鼻腔通气相关疾病发展中起到不可忽视的作用。本文就鼻腔框架结构畸形影响鼻腔结构及鼻窦气化的CT影像研究进行综述,以期为鼻腔框架结构畸形制定相关干预策略以及其后续研究提供参考。

Abstract

As the gateway to the respiratory tract, the nasal cavity facilitates the filtration of air particles, olfaction, and the heating and humidification of the air through external air exchange. Nasal framework deformation, which primarily affects nasal airflow, refers to abnormalities in the bony and cartilaginous structures of the nasal cavity. Nasal sinus CT, the main diagnostic tool for assessing nasal framework deformation, is clinically used to observe the anatomy of the nasal cavity and sinuses, as well as to analyze nasal airflow dynamics after three-dimensional reconstruction. Recent CT studies have increasingly reported that nasal framework deformation is closely related to the anatomy of the nasal cavity and sinuses. This deformation has been associated with the progression and prognosis of diseases such as chronic rhinosinusitis, silent sinus syndrome, obstructive sleep apnea-hypopnea syndrome, unilateral chronic dacryocystitis and upper airway cough syndrome. These findings suggest that nasal framework deformation may play a critical role in developing nasal ventilation-related diseases. This study summarized CT studies on the impact of nasal framework deformation on nasal structure and sinus pneumatization, aiming to provide insights for formulating intervention strategies and guiding future research on nasal framework deformities.

关键词

鼻腔框架结构畸形 / 鼻腔结构 / 鼻窦气化

Key words

Nasal framework deformation / Nasal cavity structure / Nasal sinus pneumatization

参考文献

[1] Ors S . Osseous-cartilaginous spreader graft and nasal framework reconstruction[J]. Aesthetic Plast Surg, 2017, 41(5): 1155-1163. doi: 10.1007/s00266-017-0916-x

[2] 梁丽 . 0-12岁汉族正常人群鼻腔形态及鼻唇发育的研究[D]. 重庆: 重庆医科大学, 2013

[3] 闫淯淳, 吴朔春, 袁新宇, 等 . 儿童鼻窦正常气化规律初探[J]. 中华耳鼻咽喉头颈外科杂志, 2011, 46(8): 650-653. doi: 10.3760/cma.j.issn.1673-0860.2011.08.008

[4] YAN Yuchun , WU Shuochun , YUAN Xinyu , et al. Preliminary study on normal aerification of paranasal sinuses in children[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2011, 46(8): 650-653. doi: 10.3760/cma.j.issn.1673-0860.2011.08.008

[5] 赵晓畅, 李祖飞, 任媛媛, 等 . 鼻中隔偏曲与上颌窦气化分型的相关性分析[J]. 中国耳鼻咽喉颅底外科杂志, 2023, 29(2): 101-105. doi: 10.11798/j.issn.1007-1520.202322543

[6] ZHAO Xiaochang , LI Zufei , REN Yuanyuan , et al. Correlation analysis between nasal septum deviation and maxillary sinus pneumatization classification[J]. Chinese Journal of Otorhinolaryngology-Skull Base Surgery, 2023, 29(2): 101-105. doi: 10.11798/j.issn.1007-1520.202322543

[7] Atsal G , Demir E , Yildirim O , et al. The relationship between degree of nasal septum deviation with sinonasal structures and variations[J]. J Craniofac Surg, 2022, 33(5): e447-e449. doi: 10.1097/SCS.0000000000008274

[8] Thakur P , Potluri P , Kumar A , et al. Sphenoid sinus and related neurovascular structures-anatomical relations and variations on radiology-a retrospective study[J]. Indian J Otolaryngol Head Neck Surg, 2021, 73(4): 431-436. doi: 10.1007/s12070-020-01966-y

[9] 臧洪瑞, 李立锋, 张罗, 等 . 鼻腔扩容术对上气道流场特征的影响[J]. 中国耳鼻咽喉头颈外科, 2015, 22(11): 548-553. doi: 10.16066/j.1672-7002.2015.11.003

[10] ZANG Hongrui , LI Lifeng , ZHANG Luo , et al. Effects of nasal cavity ventilation expansion techniques on airflow patterns of the upper airway[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2015, 22(11): 548-553. doi: 10.16066/j.1672-7002.2015.11.003

[11] Liu DH , Chen H , Wong BJ . Anatomy and physiology of the nasal valves[J]. Otolaryngol Clin North Am, 2025, 58(2): 189-203. doi: 10.1016/j.otc.2024.09.001

[12] Yağmur Ç , Evin N , Kelahmetoğlu O , et al. Countergrafting of dorsal septum in crooked nose[J]. Aesthetic Plast Surg, 2020, 44(5): 1707-1715. doi: 10.1007/s00266-020-01756-5

[13] Mladina R . The role of maxillar morphology in the development of pathological septal deformities[J]. Rhinology, 1987, 25(3): 199-205

[14] Rao JJ , Vinay Kumar EC , Babu KR , et al. Classification of nasal septal deviations: relation to sinonasal pathology[J]. Indian J Otolaryngol Head Neck Surg, 2005, 57(3): 199-201. doi: 10.1007/BF03008013

[15] Shetty SR , Al Bayatti SW , Al-Rawi NH , et al. Analysis of inferior nasal turbinate width and concha bullosa in subjects with nasal septum deviation: a cone beam tomography study[J]. BMC Oral Health, 2021, 21(1): 206. doi: 10.1186/s12903-021-01576-2

[16] Codari M , Zago M , Guidugli GA , et al. The nasal septum deviation index (NSDI) based on CBCT data[J]. Dentomaxillofac Radiol, 2016, 45(2): 20150327. doi: 10.1259/dmfr.20150327

[17] 强笔, 雷红卫, 王衡, 等 . 鼻瓣区螺旋CT测量的改良[J]. 临床耳鼻咽喉头颈外科杂志, 2011, 25(11): 512-513. doi: 10.3969/j.issn.1001-1781.2011.11.011

[18] Kar M , Altıntaş M . The incidence of concha bullosa: a retrospective radiologic study[J]. Eur Arch Otorhinolaryngol, 2023, 280(2): 731-735. doi: 10.1007/s00405-022-07552-y

[19] Yang BT , Chong VH , Wang ZC , et al. CT appearance of pneumatized inferior turbinate[J]. Clin Radiol, 2008, 63(8): 901-905. doi: 10.1016/j.crad.2008.01.011

[20] Teitelbaum JI , Barrett DM . Nasal airway obstruction structure and function[J]. JAMA Otolaryngol Head Neck Surg, 2020, 146(5): 512. doi: 10.1001/jamaoto.2020.0165

[21] Kimbell JS , Gross EA , Joyner DR , et al. Application of computational fluid dynamics to regional dosimetry of inhaled chemicals in the upper respiratory tract of the rat[J]. Toxicol Appl Pharmacol, 1993, 121(2): 253-263. doi: 10.1006/taap.1993.1152

[22] Lim ZF , Rajendran P , Musa MY , et al. Nasal airflow of patient with septal deviation and allergy rhinitis[J]. Vis Comput Ind Biomed Art, 2021, 4(1): 14. doi: 10.1186/s42492-021-00080-2

[23] Chen XB , Lee HP , Chong VFH , et al. Assessment of septal deviation effects on nasal airflow: a computational fluid dynamics model[J]. Laryngoscope, 2009, 119(9): 1730-1736. doi: 10.1002/lary.20585

[24] Leite SP , Jain R , Douglas RG . The clinical implications of computerised fluid dynamic modelling in rhinology[J]. Rhinology, 2019, 57(1): 2-9. doi: 10.4193/Rhin18.035

[25] 李骋, 周兵, 曲静, 等 . 基于影像重建和数值模拟技术研究轮廓化术后额隐窝及额窦解剖结构变化对鼻气流的影响[J]. 中华耳鼻咽喉头颈外科杂志, 2019, 54(11): 805-512. doi: 10.3760/cma.j.issn.1673-0860.2019.11.002

[26] LI Cheng , ZHOU Bing , QU Jing , et al. Effect of anatomical changes of frontal recess and frontal sinus on airflow after nasalisation by image reconstruction and numerical simulation[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2019, 54(11): 805-512. doi: 10.3760/cma.j.issn.1673-0860.2019.11.002

[27] Tretiakow D , Tesch K , Markiet K , et al. Maxillary sinus aeration analysis using computational fluid dynamics[J]. Sci Rep, 2022, 12(1): 10376. doi: 10.1038/s41598-022-14342-3

[28] Becker S , Huppertz T , Möller W , et al. Xenon-enhanced dynamic dual-energy CT is able to quantify sinus ventilation using laminar and pulsating air-/gas flow before and after surgery: a pilot study in a cadaver model[J]. Front Allergy, 2022, 3: 829898. doi: 10.3389/falgy.2022.829898

[29] WANG J , DOU X , LIU D , et al. Assessment of the effect of deviated nasal septum on the structure of nasal cavity[J]. Eur Arch Otorhinolaryngol, 2016, 273(6): 1477-1480. doi: 10.1007/s00405-015-3770-y

[30] Serifoglu I , Oz II , Damar M , et al. Relationship between the degree and direction of nasal septum deviation and nasal bone morphology[J]. Head Face Med, 2017, 13(1): 3. doi: 10.1186/s13005-017-0136-2

[31] Shetty SR , Al Bayatti SW , Al-Rawi NH , et al. The effect of concha bullosa and nasal septal deviation on palatal dimensions: a cone beam computed tomography study[J]. BMC Oral Health, 2021, 21(1): 607. doi: 10.1186/s12903-021-01974-6

[32] Lee DC , Shin JH , Kim SW , et al. Anatomical analysis of nasal obstruction: nasal cavity of patients complaining of stuffy nose[J]. Laryngoscope, 2013, 123(6): 1381-1384. doi: 10.1002/lary.23841

[33] 叶旻斐 . 鼻中隔偏曲对侧下鼻甲骨角度变化的CT分析[J]. 武夷学院学报, 2019, 38(9): 72-79. doi: 10.14155/j.cnki.35-1293/g4.2019.09.014

[34] YE Minfei . An analysis of the change in angle of inferior turbinate bone in the opposite side of nasal septum deviation by CT[J]. Journal of Wuyi University, 2019, 38(9): 72-79. doi: 10.14155/j.cnki.35-1293/g4.2019.09.014

[35] Berger G , Hammel I , Berger R , et al. Histopathology of the inferior turbinate with compensatory hypertrophy in patients with deviated nasal septum[J]. Laryngoscope, 2000, 110(12): 2100-2105. doi: 10.1097/00005537-200012000-00024

[36] Kapusuz Gencer Z , Ozkıriş M , Okur A , et al. The effect of nasal septal deviation on maxillary sinus volumes and development of maxillary sinusitis[J]. Eur Arch Otorhinolaryngol, 2013, 270(12): 3069-3073. doi: 10.1007/s00405-013-2435-y

[37] Sapmaz E , Kavaklı A , Sapmaz HI , et al. Impact of hard palate angulation caused by septal deviation on maxillary sinus volume[J]. Turk Arch Otorhinolaryngol, 2018, 56(2): 75-80. doi: 10.5152/tao.2018.2987

[38] Kalabalık F , Tarım Ertaş E . Investigation of maxillary sinus volume relationships with nasal septal deviation, concha bullosa, and impacted or missing teeth using cone-beam computed tomography [ J ]. Oral Radiol, 2019, 35(3): 287-295. doi: 10.1007/s11282-018-0360-x

[39] Kalsotra G , Saroch P , Gupta A , et al. The variations in deviation of nasal septum and their impact on maxillary sinus volume and occurrence of sinusitis[J]. Indian J Otolaryngol Head Neck Surg, 2023, 75(3): 1762-1766. doi: 10.1007/s12070-023-03710-8

[40] Özdemir A , Bayar Muluk N , Tursun S , et al. Maxillary sinus volume and mucosal thickening according to the septal deviation angle and age of the children[J]. J Investig Med, 2023, 71(3): 254-264. doi: 10.1177/10815589221140598

[41] Tassoker M , Magat G , Lale B , et al. Is the maxillary sinus volume affected by concha bullosa, nasal septal deviation, and impacted teeth? A CBCT study[J]. Eur Arch Otorhinolaryngol, 2020, 277(1): 227-233. doi: 10.1007/s00405-019-05651-x

[42] Rodriguez Betancourt AB , Martinez Somoza LJ , Romero Mesa C , et al. Relationship of maxillary sinus volume and nasal septum deviation: a cone beam computed tomography study[J]. Diagnostics, 2024, 14(6): 647. doi: 10.3390/diagnostics14060647

[43] Yüksel Aslier NG , Zeybek G , Karabay N , et al. The relationships between craniofacial structure and frontal sinus morphology: evaluation with conventional anthropometry and CT-based volumetry[J]. Ear Nose Throat J, 2020, 99(10): 637-647. doi: 10.1177/0145561319876927

[44] Akgül MH , Muluk NB , Burulday V , et al. Is there a relationship between sphenoid sinus types, septation and symmetry; and septal deviation?[J]. Eur Arch Otorhinolaryngol, 2016, 273(12): 4321-4328. doi: 10.1007/s00405-016-4138-7

[45] Orhan I , Ormeci T , Bilal N , et al. Morphometric analysis of sphenoid sinus in patients with nasal septum deviation[J]. J Craniofac Surg, 2019, 30(5): 1605-1608. doi: 10.1097/SCS.0000000000005443

[46] Tang J , Hou J , Zhang Y , et al. Impact of nasal septum deviation on the sphenoid bone pneumatization: a retrospective computed tomography study[J]. Acta Otolaryngol, 2025, 1-7. doi: 10.1080/00016489.2025.2455761

[47] 杨旭雯, 张郅瑾, 王彦君, 等 . 鼻中隔偏曲对中鼻甲位置的影响及其临床意义[J]. 中国耳鼻咽喉颅底外科杂志, 2022, 28(1): 75-8. doi: 10.11798/j.issn.1007-1520.202221128

[48] YANG Xuwen , ZHANG Zhijin , WANG Yanjun , et al. Influence of nasal septum deviation on the position of middle turbinate and its clinical significance[J]. Chinese Journal of Otorhinolaryngology-Skull Base Surgery, 2022, 28(1): 75-78. doi: 10.11798/j.issn.1007-1520.202221128

[49] Shetty SR , Al Bayatti SW , Al-Rawi NH , et al. Analysis of inferior nasal turbinate width and concha bullosa in subjects with nasal septum deviation: a cone beam tomography study[J]. BMC Oral Health, 2021, 21(1): 206. doi: 10.1186/s12903-021-01576-2

[50] Refaat R , Basha MAA . The impact of sphenoid sinus pneumatization type on the protrusion and dehiscence of the adjacent neurovascular structures: a prospective MDCT imaging study[J]. Acad Radiol, 2020, 27(6): e132-e139. doi: 10.1016/j.acra.2019.09.005

[51] Mohebbi A , Rajaieh S , Safdarian M , et al. The sphenoid sinus, foramen rotundum and vidian canal: a radiological study of anatomical relationships[J]. Braz J Otorhinolaryngol, 2017, 83(4): 381-387. doi: 10.1016/j.bjorl.2016.04.013

[52] Sharma BN , Panta OB , Lohani B , et al. Computed tomography in the evaluation of pathological lesions of paranasal sinuses[J]. J Nepal Health Res Counc, 2015, 13(30): 116-120

[53] 孙晓卫, 窦芬芬, 李文杰, 等 . 1~12岁儿童鼻中隔偏曲发生率与鼻窦炎相关性的CT研究[J]. 临床耳鼻咽喉头颈外科杂志, 2015, 29(20): 1770-1772. doi: 10.13201/j.issn.1001-1781.2015.20.003

[54] SUN Xiaowei , DOU Fenfen , LI Wenjie , et al. Study on the correlation between nasal septum deviation and sinusitis based on CT scan among 1-12 years old children[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2015, 29(20): 1770-1772. doi: 10.13201/j.issn.1001-1781.2015.20.003

[55] Subbotina MV , Kokhanov VS . The effect of various types of nasal septal deviation, concha bullosa and hypertrophic inferior turbinate on the development of sinusitis[J]. Vestn Otorinolaringol, 2021, 86(3): 78-83. doi: 10.17116/otorino20218603178

[56] Kamani T , Yılmaz T , Sürücü S , et al. Histopathological changes in nasal mucosa with nasal septum deviation[J]. Eur Arch Otorhinolaryngol, 2014, 271(11): 2969-2974. doi: 10.1007/s00405-014-2990-x

[57] 殷雍凯 . CT影像分析OMC变异与鼻中隔偏曲及鼻旁窦炎的关系[J]. 中国医学文摘(耳鼻咽喉科学), 2023, 38(2): 111-3. doi: 10.19617/j.issn1001-1307.2023.02.111

[58] YIN Yongkai . CT image analysis of the relationship between OMC variation and deviation of nasal septum and paranasal sinusitis[J]. Chinese Medical Digest (Otorhinolaryngology), 2023, 38(2): 111-3. doi: 10.19617/j.issn1001-1307.2023.02.111

[59] Fadda GL , Rosso S , Aversa S , et al. Multiparametric statistical correlations between paranasal sinus anatomic variations and chronic rhinosinusitis[J]. Acta Otorhinolaryngol Ital, 2012, 32(4): 244-251

[60] Fiorenza UD , Spoldi C , Nekrasova L , et al. Prevalence of maxillary sinus hypoplasia and silent sinus syndrome: a radiological cross-sectional retrospective cohort study[J]. Am J Rhinol Allergy, 2022, 36(1): 123-128. doi: 10.1177/19458924211029418

[61] Martínez-Capoccioni G , Varela-Martínez E , Martín-Martín C . Silent sinus syndrome acquired condition and the essential role of otorhinolaryngologist consultation: a retrospective study[J]. Eur Arch Otorhinolaryngol, 2016, 273(10): 3183-3188. doi: 10.1007/s00405-016-3965-x

[62] Mupparapu M , Shi KJ , Lo AD , et al. Novel 3D segmentation for reliable volumetric assessment of the nasal airway: a CBCT study[J]. Quintessence Int, 2021, 52(2): 154-164. doi: 10.3290/j.qi.a45429

[63] Suga H , Iwasaki T , Mishima K , et al. Evaluation of the effect of oral appliance treatment on upper-airway ventilation conditions in obstructive sleep apnea using computational fluid dynamics[J]. Cranio, 2021, 39(3): 209-217. doi: 10.1080/08869634.2019.1596554

[64] Zhang XM , Lv N , Li X , et al. The value of drug-induced sleep computed tomography in diagnosis of obstructive sleep apnea syndrome: a pilot study[J]. Acta Otolaryngol, 2019, 139(10): 895-901. doi: 10.1080/00016489.2019.1632480

[65] 王效军, 王宇, 赵佳佳, 等 . 成人重度阻塞性睡眠呼吸暂停低通气综合征患者呼吸暂停低通气指数与硬腭高度、宽度及鼻腔高度的相关性[J]. 中国耳鼻咽喉头颈外科, 2023, 30(5): 334-336. doi: 10.16066/j.1672-7002.2023.05.015

[66] Miyamura K , Nakashima D , Nakayama T , et al. Morphology of nasal septal deviation in obstructive sleep apnea patients and its treatment method[J]. Laryngoscope, 2025, 135(4): 1520-1524. doi: 10.1002/lary.31876

[67] 魏洪政, 高翔, 张媛, 等 . 鼻腔扩容手术对阻塞性睡眠呼吸暂停低通气综合征患者睡眠改善作用的回顾性分析[J]. 中国耳鼻咽喉头颈外科, 2023, 30(06): 382-7. doi: 10.16066/j.1672-7002.2023.06.010

[68] WEI Hongzheng , GAO Xiang , ZHANG Yuan , et al. A retrospective analysis of the effect of nasal cavity ventilation expansion techniques on sleep improvement in patients with OSAHS[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2023, 30(06): 382-7. doi: 10.16066/j.1672-7002.2023.06.010

[69] 张庆泉, 宋西成, 张华, 等 . 鼻部手术联合其他平面手术治疗OSAHS疗效分析[J]. 山东大学耳鼻喉眼学报, 2008, (2): 102-104

[70] 敬尚林, 林楠, 唐向荣, 等 . 上气道相关性手术治疗儿童上气道咳嗽综合征的临床价值[J]. 实用医学杂志, 2017, 33(24): 4201-4202. doi: 10.3969/j.issn.1006-5725.2017.23.047

[71] Dąbrowska M , Arcimowicz M , Grabczak EM , et al. Chronic cough related to the upper airway cough syndrome: one entity but not always the same[J]. Eur Arch Otorhinolaryngol, 2020, 277(10): 2753-2759. doi: 10.1007/s00405-020-06071-y

[72] Yasuda K . Upper airway cough syndrome may be the main cause of chronic cough in Japan: a cohort study[J]. Fam Pract, 2021, 38(6): 751-757. doi: 10.1093/fampra/cmab046

[73] 高英 . 慢性泪囊炎与鼻腔结构异常的关系[D]. 延安: 延安大学, 2016

[74] 郭思睿, 莫亚 . CT检查联合计算机三维重建指导泪道手术研究进展[J]. 山东大学耳鼻喉眼学报, 2024, 38(4): 175-82. doi: 10.6040/j.issn.1673-3770.0.2023.114

[75] GUO Sirui , MO Ya . Computer-aided 3D reconstruction based on CT imaging for guidance in lacrimal duct surgery[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2024, 38(04): 175-82. doi: 10.6040/j.issn.1673-3770.0.2023.114

[76] 莫亚, 艾贤琳, 姚月姣, 等 . 单眼慢性泪囊炎患者鼻中隔偏曲的情况观察[J]. 中国中医眼科杂志, 2024, 34(5): 425-428. doi: 10.13444/j.cnki.zgzyykzz.2024.05.005

[77] MO Ya , AI Xianlin , YAO Yuejiao , et al. Observation of nasal septal deviation in patients with unilateral chronic dacryocystitis[J]. China Journal of Chinese Ophthalmology, 2024, 34(5): 425-428. doi: 10.13444/j.cnki.zgzyykzz.2024.05.005

[78] Zhang JG , Ming S , Qing HL , et al. Prognosis of concurrent endoscopic dacryocystorhinostomy and nasal septoplasty for chronic dacryocystitis with moderate nasal septum deviation[J]. Indian J Ophthalmol, 2024, 72(3): 435-440. doi: 10.4103/IJO.IJO_1970_23

基金资助

江苏省医学重点学科(ZDXK202243)

南京鼓楼医院临床研究专项(2022-LCYJ-MS-31)

南京市医学重点科技发展项目(ZKX24017)