Nasal septal deformities in ear, nose, and throat patients:
An international study
Ranko Mladina, MD, PhD
, Emil C
, MD, PhD
, Katarina Vukovic
ORL Klinika S
alata 4, 10.000 Zagreb, Croatia
ORL odjel., Klinicˇka bolnica Dubrava, Av. G. S
usˇka bb, 10.000 Zagreb, Croatia
Received 17 November 2006
Purpose: The purpose of this study was to investigate the incidence and characteristics of nasal
septum deformities in ear, nose, and throat (ENT) patients in various geographic regions in the world.
Materials and methods: Anterior rhinoscopy without nasal decongestion was performed in 17 ENT
centers in 14 countries. The septal deformities were classified according to the classification system
proposed by Mladina.
Results: A total of 2589 adult ENT patients (1500 males and 1089 females) were examined. Septal
deformities were found in 89.2% of subjects. Left-sided deformities were slightly more prevalent
than right-sided deformities (51.6% and 48.4%, respectively). The most frequent type of deformity
was type 3 (20.4%). Straight septum was found in 15.4% of females and 7.5% of males.
Conclusions: Almost 90% of the subjects showed 1 of the 7 types of septal deformity. There were
no statistically significant differences in the incidence of their appearance among particular
geographic regions. Type 3 was the most frequent type. Straight septum was twice as frequent in
females than in males.
D 2008 Elsevier Inc. All rights reserved.
There are many articles on nasal septal deformities in
the rhinologic literature; however, there lacks a standard-
ized way for describing particular septal deformities. What
one can find in most of these articles is just septal deviation
or deviated nasal septum, without a precise description of
its appearance. Attempts to comprehensively systematize
septal deformities started almost 30 years ago at the ear,
nose, and throat (ENT) department of the University
Hospital Salata in Zagreb, Croatia. They led to a simple
classification in 7 types published by Mladina  in 1987.
This classification was derived from research in Croatia,
but what about other populations? Does the classification
apply to other geographic regions?
Studies have shown great differences in the morpholog-
ical and cephalometric values in subjects from various
geographic regions. Gurr et al  showed that there are
considerable differences in the geometry of both external
nose and nasal cavities among subjects belonging to various
races and ethnic groups. This is in accordance with other
studies [3,4]. Richardson and Marrett  found great
differences in facial bone shape between British and West
African populations, and Marcellino et al  found
significant differences in the height of the middle facial
massif in 6 South American Indian tribes. Japanese authors
found remarkable differences in the thickness of the cranial
bones of the Neolithic and modern Japanese population ,
and some authors have also found secular changes in the
main skull dimensions .
It is known that the angulation of the skull base in
humans can act like a sort of bcranial pincerQ and squeeze
the splanchnocranial structures, including the nasal septum,
0196-0709/$ – see front matter D 2008 Elsevier Inc. All rights reserved.
4 Corresponding author. ORL Klinika S
alata-KBC, 10000 Zagreb,
Croatia. Tel.: +385 1 4810377; fax: +385 1 2347258.
E-mail addresses: prof
email@example.com (R. Mladina)8
firstname.lastname@example.org (E. C
)8 email@example.com (M. S
firstname.lastname@example.org (K. Vukovic
Tel.: +385 1 4920012; fax: +385 1 2347258.
Tel.: +385 1 290 2401; fax: +385 1 2334856.
American Journal of Otolaryngology–Head and Neck Medicine and Surgery 29 (2008) 75 – 82
Available online at www.sciencedirect.com