engleski

Biofilm: Does it have any clinical impact?

According to well known classification of septal deformities in seven well defined types, some clini¬cally important implications have been stressed out during decades of experience. Type 1 means unilateral vertical ridge in a valve which does not correspond with the nasal valve, so in most of the cases has no considerable clinical importance except when connected to subluxation of the columel- lar septal edge. The subluxation itself could bother patient both in aesthetic and functional sense. Type 2 means unilateral vertical ridge, this time much more emphasized, i.e. involving valve and thus remarkably impairing the quality of nasal breathing to the respective side of the nose. Type 3 means unilateral vertical ridge next to the anterior edge of the head of the middle turbinate. The nasal cavity is very narrow on one side and very wide on the other. One can find a pneumatized middle turbinate at the wider side in more than 91% of all cases. Type 3 seems to be the most frequent septal deformity in all cases of chronic sinusitis. Type 4 is a bilateral vertical deformity consisting of previously mentioned types, type 2 at one side, and type 3 at the other (so called S-shaped septum, or vice versa). Clinically, it summarizes all negative clinical implications of both types. Type 5 is again a unilateral deformity, this time a horizontal crest which is as more lateral as deeper in the nose, in most of the cases resulting in an impaction of the crest at the region of the sphenopalatine ganglion. Clinically, it always means unilaterally impaired nasal breathing, sometimes could provoke ipsilateral intermittent attacks of headache and sometimes could influence the development of chronic oti¬tis media since it mechanically disturbs normal direction of mucous drainage from the ostiomeatal complex to the nasopharynx directing it to the Eustachian tube orifice. This type is an absolutely inherited deformity. Type 6 is also a horizontal deformity, consisting of an anteriorly positioned basal septal crest, frequently touching mucosa of the inferior turbinate on one side, and the massive wing of the intermaxillary bone, which sticks laterally thus creating a deep gutter between nasal septum and the wing. Clinically, this type is seen in more than 96% of all children suffering from cleft lip/pal- ate, and in more of 76% of their parents. Additionally, in subjects without manifest cleft one must palpate hard and soft palate (submucosal cleft?), take a precise look to the uvula (bifid?), and obliga¬tory perform an analysis of the subject's hearing abilities because submucosally hidden weakness of the palate could also mean a weakness of levator velli palatini and tensor velli palatini muscles. The weakness of these two muscles directly influences the impairment of the Eustachian tube orifice function, ventilation and drainage of the middle ear. This type, as in case of type 5, is absolutely in¬herited deformity. Type 7 is very variable and presents a combination of previously mentioned types with all their negative clinical implications.

biofilm ; clinical implications

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