Nasal Septal Deviations: A Systematic Review of Classification Systems

Table 1

Studies meeting criteria for internal nasal septal deviation classification systems and a summary of the descriptions.

Author, year, location	Description of internal nasal septal deviation classification systems
Lin et al., 2014, USA [44]	Various points on computed tomography imaging which were analyzed by computer software that compared contours of a deviated septum as compared to an ideal straight septum. Points assessed included the perpendicular plate of the ethmoid bone and vomer bone junction, nasal spine, nasal bone, crista galli, and midpoint between the perpendicular plate-vomer junction and nasal spine.
Salihoglu et al., 2014, Turkey [45]	Grade 1: 0–33% deflection from midline toward lateral wall, Grade 2: 34–66% deflection from midline toward the lateral wall, and Grade 3: 67–100% deflection from the midline toward the lateral wall.
Vidigal et al., 2013, Italy [41]	Degree I: the deviation did not reach the lower nasal turbinate, Degree II: the deviation reached the lower nasal turbinate, and Degree III: the deviation reached the lateral wall and compressed the lower nasal turbinate.
Lee and Baker, 2013, USA [43]	Caudal septum is straight but deviated from the midline and is usually displaced from the maxillary crest, C-shaped septal deformity in the vertical plane, C-shaped septal deformity in the horizontal plane, S-shaped septal deformity in the horizontal plane, and S-shaped septal deformity in the vertical plane.
Reitzen et al., 2011, USA [6]	Tortuosity is measured at 4 defined points along the length of internal nasal septum. A ratio of the actual length of the septum () and the ideal length () is calculated as .
Cerkes, 2011, Turkey [33]	Caudal septal deviation (septal tilt), anteroposterior C- and S-shaped deviation, and cephalocaudal C- and S-shaped deviations.
Jin et al., 2007, Korea [26]	Type I: localized deviation including spur (spine), crest, or caudal dislocation, Type II: curved/angulated deviation without localized deviation, Type III: curved/angulated deviation with localized deviation, and Type IV: curved/angulated deviation with associated external nasal deformity.
I. Baumann and H. Baumann, 2007, Germany [25]	Types based on primary deviation, each type has several additional features: Type 1: septal crest, Type 2: cartilaginous deviated nose, Type 3: high septal crest deviation, Type 4: caudally inclined septum, Type 5: septal crest, and Type 6: caudally inclined septum.
Rao et al., 2005, India [23]	Type I: midline septum or mild deviations in vertical or horizontal plane, Type II: anterior vertical deviation, Type III: posterior vertical deviation, Type IV: S-septum, Type V: horizontal spur on one side, Type VI: type V with a deep grove on the concave side, and Type VII: combination of II–VI.
Buyukertan et al., 2003, Turkey [48]	The septum is divided into 10 segments: anterosuperior (AS), anteromedial (AM), anteroinferior (AI), mediosuperior (MS), mediomedia (MM), medioinferior (MI), posterosuperior (PS), posteromedial (PM), posteroinferior (PI), and caudal end of the septum nasi (CE).
Rohrich et al., 2002, USA [3]	Caudal septal deviation (straight septal tilt, C-shaped, and S-shaped), concave dorsal deformity (C-shaped dorsal deformity and reverse C-shaped dorsal deformity), and concave/convex dorsal deformity (S-shaped).
Guyuron et al., 1999, USA [16]	C-shape anteroposterior deviation, C-shape cephalocaudal, S-shape anteroposterior, S-shape cephalocaudal, septal tilt deformity, and localized deviations or large spurs.
Mladina, 1987, Croatia [27]	Type 1: unilateral vertical septal ridge in the valve region that does not reach the valve itself, Type 2: unilateral vertical septal ridge in the valve region touching the nasal valve, Type 3: unilateral vertical ridge located more deeply in the nasal cavity, Type 4: S-shaped, Type 5: almost horizontal septal spur, Type 6: massive unilateral bone spur, and Type 7: variation.
Lawson,; 1978, Canada [51]	C-shaped, S-shaped, and deviated nose, twisted nose, and skeletal asymmetry (depressed nasal fracture).
Sawhney and Sinha, 1964, India [8]	Grade deviations as mild, moderate, and marked (cannot see middle turbinate on side of the deviation). Cartilage and bony deflection, dislocation of septal cartilage, and level of deviation.