title: The accuracy of different methods for diagnosing septal deviation in patients undergoing septorhinoplasty: A prospective study.
abstract: OBJECTIVE
  This study aimed to determine the diagnostic accuracy of different diagnostic tests in predicting nasal septum deformities during preoperative planning for septorhinoplasty.
  
  
  METHODS
  Consecutive patients who underwent septorhinoplasty between June 2011 and August 2012 were included (n = 30) and underwent a protocol of diagnostic tests, including nasal speculoscopy, craniofacial computed tomography (CT), three-dimensional (3D) reconstruction of the nasal septum by CT and nasal endoscopy. A modified Guyuron classification of septal deformities was used for classifying the septal deviations. Direct surgical assessment of the nasal septum during open septorhinoplasty was the reference standard with which each of the diagnostic tests was compared. Sensitivity, specificity and predictive values of each test were calculated.
  
  
  RESULTS
  The preoperative diagnosis was nasal bone fracture in 11 patients, nasal septal fracture in 15 and post-traumatic nasal deformity in four. For type A deviations (localised), craniofacial CT showed the highest performance with a sensitivity of 100%, specificity of 100%, positive predictive value (PPV) of 100% and negative predictive value (NPV) of 99%. For type B septal deformations (C shape), nasal endoscopy (sensitivity, 100%; specificity, 87.5%; PPV, 87.7%; and NPV, 100%) showed the highest performance. For type C deformities (S shape), nasal endoscopy (sensitivity, 70%; specificity, 100%; PPV, 100%; and NPV, 87%) showed the highest performance. The accuracy for nasal endoscopy was 27/30 (90%), 26/30 (87%) for craniofacial CT, 22/30 (73%) for 3D reconstruction and 10/28 (36%) for speculoscopy.
  
  
  CONCLUSIONS
  Nasal endoscopy and craniofacial CT were more accurate and precise than nasal speculoscopy and 3D reconstruction for preoperative evaluation of the nasal septum, thus enabling more appropriate surgical planning for septorhinoplasty.
authors.affiliation: Division of Maxillofacial Surgery, Hospital del Trabajador, Santiago, Chile; Division of Plastic Surgery, Department of Surgery, Hospital Clínico de la Universidad de Chile, Santiago, Chile. Electronic address: pandrades@uchile.cl.
authors.forename: Patricio
authors.initials: P
authors.lastname: Andrades
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Hospital Clínico de la Universidad de Chile, Santiago, Chile.
authors.forename: Pedro
authors.initials: P
authors.lastname: Cuevas
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Hospital Clínico de la Universidad de Chile, Santiago, Chile.
authors.forename: Stefan
authors.initials: S
authors.lastname: Danilla
authors.affiliation: Division of Maxillofacial Surgery, Hospital del Trabajador, Santiago, Chile.
authors.forename: Joaquin
authors.initials: J
authors.lastname: Bernales
authors.affiliation: Division of Maxillofacial Surgery, Hospital del Trabajador, Santiago, Chile.
authors.forename: Cristobal
authors.initials: C
authors.lastname: Longton
authors.affiliation: Division of Maxillofacial Surgery, Hospital del Trabajador, Santiago, Chile.
authors.forename: Claudio
authors.initials: C
authors.lastname: Borel
authors.affiliation: Division of Maxillofacial Surgery, Hospital del Trabajador, Santiago, Chile.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Hernández
authors.affiliation: Division of Maxillofacial Surgery, Hospital del Trabajador, Santiago, Chile.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Villalobos
mesh_terms: D000328:Adult; D002677:Chile; D061827:Dimensional Measurement Accuracy; D004724:Endoscopy / Q000379:methods; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D009300:Nasal Septum / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D009667:Nose Deformities, Acquired / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods / Q000592:standards; D011446:Prospective Studies; D012015:Reference Standards; D012225:Rhinoplasty / Q000379:methods*; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: Diagnostic study; Imaging; Nasal septum; Septorhinoplasty