A paradigm shift: “Defect of the fontanel” instead of “Accessory ostium” and classified nasal septal deformities instead of “septal deviation”

Ranko Mladina 1 , Neven Skitarelić 2 , 3 , Cemal Cingi 4 , and Nuray Bayar Muluk 5
  • 1 The Board of Surgical Sciences, Croatian Academy of Medical Sciences, , Zagreb, Croatia
  • 2 Department of Health Studies, University of Zadar, Zadar, Croatia
  • 3 Faculty of Medicine, University of Rijeka, Rijeka, Croatia
  • 4 ENT Head and Neck Surgery Department, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
  • 5 ENT Head and Neck Surgery Department, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey


OBJECTIVES. The purpose of this article is to highlight some terms which have been ingrained in the rhinosinusology literature.

MATERIAL AND METHODS. It regards the term “accessory ostium” and the term “septal deviation”. The well-known and deeply ingrained term “accessory ostium” has been widely used for decades, but essentially it is absolutely incorrect. “Septal deviation” is an inadequate term for the changes of the nasal septum form.

RESULTS. From the linguistic point of view, “accessory” means something (or someone) which (or who) helps someone or gives support (to something or someone) in some process. We recommend the use of the term “defect of the fontanel” instead of “accessory ostium”. The use of the term “septal deformity” (from Latin: de forma, meaning the change in the shape) is etymologically much more appropriate. Septal deformities appear in man in several, well defined shapes and, therefore, can be correctly classified. The classification contributes to the further scientific conversations regarding the clinical issues connected to the changes of the nasal septum form.

CONCLUSION. The usual term “accessory ostium” suggests almost a normal finding on the lateral nasal wall, but, on the contrary, it clearly signalizes that the respective maxillary sinus is chronically inflamed. The usual term “septal deviation” is not at all specific and only suggests that something is wrong with the position of the nasal septum. It does not at all imply any of the six well known types of septal deformities in man.

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  • 1. Hilding A. Physiology of drainage of nasal mucus. Experimental work on accessory sinuses. Am J Physiol. 1932;100:664-70. DOI: https://doi.org/10.1152/ajp;egacy.1932.100.3.664.

  • 2. Kane KJ. Recirculation of mucus as a cause of persistent sinusitis. Am J Rhinol. 1997;11(5):361-9.

  • 3. Messerklinger W. Endoscopy of the nose. Urban & Schwarzenberg; 1978.

  • 4. Mladina R, Vuković K, Poje G. The two holes syndrome. Am J Rhinol Allergy. 2009;23(6):602-4. DOI: 10.2500/ajra.2009.23.3375.

  • 5. Mladina R, Skitarelić N, Casale M. Two holes syndrome (THS) is present in more than half of the postnasal drip patients? Acta Otolaryngol. 2010;130(11):1274-7. DOI: 10.3109/00016489.2010.480983.

  • 6. Mladina R, Skitarelić N, Poje G, Šubarić M. Clinical implications of nasal septal deformities. Balkan Med J. 2015;32(2):137-46. DOI: 10.5152/balkanmedj. 2015.159957. Epub 2015 Apr 1.

  • 7. Mladina R. The role of maxillar morphology in the development of pathological septal deformities. Rhinology. 1987;25(3):199-205.

  • 8. Orlandi RR, Kingdom TT, Hwang PH, Smith TL, Alt JA, Baroody FM, et al. International Consensus Statement on Allergy and Rhinology: Rhinosinusitis. Int Forum Allergy Rhinol. 2016;6 Suppl 1:S22-209. DOI: 10.1002/alr.21695.

  • 9. Mladina R, Skitarelić N, Carić T, Raguž M. Type 5 and 6 nasal septal deformities: Could we predict and prevent acute coronary syndrome attacks in the future? Med Hypotheses. 2015;85(5):640-4. DOI: 10.1016/j.mehy.2015.08.001.

  • 10. Liang P, Xu Y, Zhang X, Ding C, Huang R, Zhang Z, et al. CRISPR/Cas9-mediated gene editing in human tripronuclear zygotes. Protein Cell. 2015;6(5):363-72. DOI: http://dx.doi.org/10.1007/s13238-015-0153-5.

  • 11. Mladina R. Skitarelić NB, Skitarelic NP. Could we prevent unilateral cleft lip/palate in the future? Medical Hypotheses. 2009;73(4):601-3. DOI: 10.1016/j.mehy.2009.05.028. Epub 2009 Jun 25.

  • 12. Mladina R, Ostojić D, Koželj V, Heinzel B, Bastaić LJ. Pathological septal deformities in cleft palate children. L’Otorinolaryngologia Pediatrica. 1997;2-3:75-80.

  • 13. Mladina R, Šubarić M. Are some septal deformities inherited? Type 6 revisited. Int J Pediatr Otorhinolaryngol. 2003;67(12):1291-4.

  • 14. Mladina R, Skitarelić N, Vuković K, Subarić M, Carić T, Orihovac Z. Unilateral cleft lip/palate children: the incidence of type 6 septal deformities in their parents. J Craniomaxillofac Surg. 2008;36(6):335-40. DOI: 10.1016/j.jcms.2008.03.003. Epub 2008 May 2.


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