Correlation of asymmetric facial growth with deviated nasal septum

Internal structural analysis of the nasomaxillary complex in patients with skeletal class III asymmetry: A study on asymmetry patterns

OBJECTIVES

To investigate the internal structure of the nasomaxillary complex, including the maxillary sinus, nasal cavity and nasal septum according to the facial asymmetry pattern and to evaluate its correlation with external maxillomandibular asymmetry in Class III patients based on cone-beam computerized tomography (CBCT) images.

MATERIALS AND METHODS

Facial asymmetry was analysed in a total of 100 Class III patients aged 16 years or older using CBCT scans. Patients were categorized into subgroups based on asymmetry pattern. Measurements of the nasomaxillary complex were obtained from the CBCT scans, including the volume and width of the maxillary sinuses and nasal cavities on deviated and non-deviated sides, as well as the displacement of the nasal septum. Statistical analysis was performed to compare the internal nasomaxillary variables within and between groups, and regression analysis was conducted to evaluate the correlation between facial asymmetry and the internal nasomaxillary variables.

RESULTS

Group comparisons showed that there were no significant differences in the volume of the maxillary sinus and nasal cavity. However, the direction and extent of nasal septum deviation, as well as the width of the nasal cavity, varied depending on the maxillary asymmetry pattern. Regression analysis indicated a correlation between nasal septum deviation and the difference in maxillary height, while the difference in nasal cavity width was correlated with the difference in maxillary width.

CONCLUSION

A comprehensive evaluation of the internal nasal anatomy is vital for understanding the intricate relationship between nasal structure and maxillary growth.

Automated surgery planning for an obstructed nose by combining computational fluid dynamics with reinforcement learning

Septoplasty and turbinectomy are among the most common interventions in the field of rhinology. Their constantly debated success rates and the lack of quantitative flow data of the entire nasal airway for planning the surgery necessitate methodological improvement. Thus, physics-based surgery planning is highly desirable. In this work, a novel and accurate method is developed to enhance surgery planning by physical aspects of respiration, i.e., to plan anti-obstructive surgery, for the first time a reinforcement learning algorithm is combined with large-scale computational fluid dynamics simulations. The method is integrated into an automated pipeline based on computed tomography imaging. The proposed surgical intervention is compared to a surgeon's initial plan, or the maximum possible intervention, which allows the quantitative evaluation of the intended surgery. Two criteria are considered: (i) the capability to supply the nasal airway with air expressed by the pressure loss and (ii) the capability to heat incoming air represented by the temperature increase. For a test patient suffering from a deviated septum near the nostrils and a bony spur further downstream, the method recommends surgical interventions exactly at these locations. For equal weights on the two criteria (i) and (ii), the algorithm proposes a slightly weaker correction of the deviated septum at the first location, compared to the surgeon's plan. At the second location, the algorithm proposes to keep the bony spur. For a larger weight on criterion (i), the algorithm tends to widen the nasal passage by removing the bony spur. For a larger weight on criterion (ii), the algorithm's suggestion approaches the pre-surgical state with narrowed channels that favor heat transfer. A second patient is investigated that suffers from enlarged turbinates in the left nasal passage. For equal weights on the two criteria (i) and (ii), the algorithm proposes a nearly complete removal of the inferior turbinate, and a moderate reduction of the middle turbinate. An increased weight on criterion (i) leads to an additional reduction of the middle turbinate, and a larger weight on criterion (ii) yields a solution with only slight reductions of both turbinates, i.e., focusing on a sufficient heat exchange between incoming air and the air-nose interface. The proposed method has the potential to improve the success rates of the aforementioned surgeries and can be extended to further biomedical flows.

Evaluation of Malocclusion Types in Adult Patients with Nasal Septal Defects - An Observational Cross-Sectional Analysis

Introduction

The nasal septum is crucial in the development of the craniofacial structures. Deviated nasal septum is one of the anatomical causes of mouth breathing which in turn lead to malocclusion.

Aims and Objectives

To evaluate the dentofacial and cephalometric characteristics in individuals with nasal breathing obstruction brought on by nasal septal deviation, as well as the relationship between these defects and various malocclusions and the degree of facial asymmetry.

Materials and Methods

A two-point evaluation was adopted for the selected patients, one at the ENT department using clinical examination and CT-PNS and the severity classified according to the Mladina classification and another at the dental department, using clinical examinations, PA cephalograms, lateral cephalograms, and facial photographs.

Results and Discussion

The association between malocclusion and various grades of septal deviation was statistically significant with a P value of 0.006. Results showed that 13 patients are with Class I skeletal pattern, 20 patients with Class II, and 7 patients with Class III skeletal pattern. None of the grade 7 nasal septal deviation patients had class I malocclusion and none of the grade 2 nasal septal deviation patients had class III malocclusion. Class II division I malocclusion was the most common type noted in patients with nasal septal deviation. Grade 7 nasal septal deviation was associated with the maximum amount of ANS and mentioned deviation indicating significant facial asymmetry.

Conclusion

Class-II Division-1 malocclusion was the most common type noted and Class III malocclusion was more common in higher grades of nasal septal deviation. Maxillary and mandibular asymmetry worsens significantly with an increase in the grade of nasal septal deviation and is one of the significant factors in causing facial asymmetry.

Role of Electrodiagnostic Modalities in Detection of Nasal Septal Deviation

Nasal Septal Deviation (NSD) is a common sign in otorhinolaryngology that can lead to facial asymmetry. In this case-control observational study, we assessed the role of EMG and NCS in the diagnosis of NSD and its effect on neuromuscular function. Participants were divided into two groups based on paranasal sinus computed tomography scan (PNS CT) results: NSD cases (n = 21) and controls without NSD (n = 13). EMG and NCS were performed on both groups to assess nasal alar muscles at the root of the zygomatic nerve. Our findings showed a significant correlation between NSD and EMG/NCS tests (P-value = 000) and a significant association between septal deviation and nasal alar lateralization (P-value = 000). EMG/NCS can be useful in assessing NSD by providing a better understanding of related neuromuscular structures and neuromuscular function of the nasal alar dilator muscles and aid in the diagnosis of NSD. Nasal Septal Deviation, EMG (electromyography), NCS (nerve conduction studies), Neuromuscular function, Facial asymmetry, Otorhinolaryngology, Paranasal sinus, Computed tomography, Nasal alar muscles, Zygomatic nerve, Nasal Obstruction, Nasal alar lateralization, Diagnosis.

Differences in facial soft tissue deviations in Class III patients with different types of mandibular asymmetry: A cone-beam computed tomography study

Objective

: This study assessed the differences in soft tissue deviations of the nose, lips, and chin between different mandibular asymmetry types in Class III patients.

Methods

: Cone-beam computed tomography data from 90 Class III patients with moderate-to-severe facial asymmetry were investigated. The sample was divided into three groups based on the extent of mandibular rolling, yawing, and translation. Soft tissue landmarks on the nose, lips, and chin were investigated vertically, transversely, and anteroposteriorly. A paired t test was performed to compare variables between the deviated (Dv) and nondeviated (NDv) sides, and one-way analysis of variance with Tukey's post-hoc test was performed for intergroup comparisons. Pearson's correlation coefficient was calculated to assess the relationship between the soft and hard tissue deviations.

Results

: The roll-dominant group showed significantly greater differences in the vertical positions of the soft tissue landmarks between the Dv and NDv than other groups (P < 0.05), whereas the yaw-dominant group exhibited larger differences in the transverse and anteroposterior directions (P < 0.05). Moreover, transverse lip cant was correlated with the menton (Me) deviation and mandibular rolling in the roll-dominant group (P < 0.001); the angulation of the nasal bridge or philtrum was correlated with the Me deviation and mandibular yawing in the yaw-dominant group (P < 0.01).

Conclusions

: The three-dimensional deviations of facial soft tissue differed based on the mandibular asymmetry types in Class III patients with similar amounts of Me deviation. A precise understanding of soft tissue deviation in each asymmetry type would help achieve satisfactory facial esthetics.

Correlation Analysis of Nasal Septum Deviation and Results of AI-Driven Automated 3D Cephalometric Analysis

The nasal septum is believed to play a crucial role in the development of the craniofacial skeleton. Nasal septum deviation (NSD) is a common condition, affecting 18-65% of individuals. This study aimed to assess the prevalence of NSD and its potential association with abnormalities detected through cephalometric analysis using artificial intelligence (AI) algorithms. The study included CT scans of 120 consecutive, post-traumatic patients aged 18-30. Cephalometric analysis was performed using an AI web-based software, CephX. The automatic analysis comprised all the available cephalometric analyses. NSD was assessed using two methods: maximum deviation from an ideal non-deviated septum and septal deviation angle (SDA). The concordance of repeated manual measurements and automatic analyses was assessed. Of the 120 cases, 90 met the inclusion criteria. The AI-based cephalometric analysis provided comprehensive reports with over 100 measurements. Only the hinge axis angle (HAA) and SDA showed significant (p = 0.039) negative correlations. The rest of the cephalometric analyses showed no correlation with the NSD indicators. The analysis of the agreement between repeated manual measurements and automatic analyses showed good-to-excellent concordance, except in the case of two angular measurements: LI-N-B and Pr-N-A. The CephX AI platform showed high repeatability in automatic cephalometric analyses, demonstrating the reliability of the AI model for most cephalometric analyses.

Association between nasal septum deviation and transverse maxillary development: A retrospective cross-sectional study

INTRODUCTION

The few studies investigating the relationship between nasal septum deviation (NSD) and maxillary development, using different assessment methods and the age of subjects, reported contradicting results.

METHODS

The association between NSD and transverse maxillary parameters was analyzed using 141 preorthodontic full-skull cone-beam computed tomography scans (mean age, 27.4 ± 9.01 years). Six maxillary, 2 nasal, and 3 dentoalveolar landmarks were measured. The intraclass correlation coefficient was used to assess intrarater and interrater reliability. The correlation between NSD and transverse maxillary parameters was analyzed using the Pearson correlation coefficient. Each transverse maxillary parameter was compared among 3 groups of different degrees of severity using the analysis of variance test. Transverse maxillary parameters were also compared between the more and less deviated nasal septum sides using the independent t test.

RESULTS

A correlation between deviated septal width and palatal arch depth (r = 0.2, P <0.013) and significant differences in palatal arch depth (P <0.05) among 3 NSD severity groups classified with deviated septal width was noted. There was no correlation between septal deviated angle and transverse maxillary parameters and no significant difference for transverse maxillary parameters among the 3 groups of NSD severity classified by septal deviated angle. No significant difference in transverse maxillary parameters was found when comparing the more and the less deviated sides.

CONCLUSIONS

This study suggests that NSD can affect palatal vault morphology. The magnitude of NSD may be a factor associated with transverse maxillary growth disturbance.

The Effect of Trans-Sutural Distraction Osteogenesis on Nasal Bone, Nasal Septum, and Nasal Airway in the Treatment for Midfacial Hypoplasia in Growing Patients

The purposes of this study were to analyze the effect of trans-sutural distraction osteogenesis (TSDO) on nasal bone, nasal septum, and nasal airway in the treatment of midfacial hypoplasia. A total of 29 growing patients with midfacial hypoplasia who underwent TSDO by a single surgeon were enrolled. The 3-dimensional measurement of nasal bone and nasal septum changes was performed using computed tomography (CT) images obtained preoperatively (T0) and postoperatively (T1). One patient was selected to establish 3-dimensional finite element models to simulate the characteristics of nasal airflow field before and after traction. After traction, the nasal bone moved forward significantly ( P <0.01). The septal deviation angle was lower than that before traction (14.43±4.70 versus 16.86 ±4.59 degrees) ( P <0.01). The length of the anterior and posterior margin of the vomer increased by 21.4% ( P <0.01) and 27.6% ( P <0.01), respectively, after TSDO. The length of the posterior margin of the perpendicular plate of ethmoid increased ( P <0.05). The length of the posterior inferior and the posterior superior margin of the nasal septum cartilage increased ( P <0.01) after traction. The cross-sectional area of nasal airway on the deviated side of nasal septum increased by 23.0% after traction ( P <0.05). The analysis of nasal airflow field showed that the pressure and velocity of nasal airflow and the nasal resistance decreased. In conclusion, TSDO can promote the growth of the midface, especially nasal septum, and increase the nasal space. Furthermore, TSDO is conductive to improve nasal septum deviation and decrease nasal airway resistance.

Influence of nasal septum deviation on fluctuating asymmetries of the nasomaxillary complex: A cross-sectional study

An important parameter in diagnostic analysis and treatment planning of different biological areas is facial symmetry, and several etiological factors have been attributed to skeletal facial asymmetry. Although causality cannot be determined, previous studies have reported a relationship between the anatomical deviation of the nasal septum and facial development. Diagnosis is critical for patients in growth stages due to the association between nasal septum deviation (NSD) and abnormal growth of the nasomaxillary complex. To understand this relationship, this study aimed to investigate the influence of nasal septum deviation on fluctuating asymmetries (FA) of the nasomaxillary complex at different stages of skeletal maturation. Another goal was to determine whether an association exists between the degrees of septal deviation severity and asymmetry of the nasomaxillary complex. This was a retrospective, cross-sectional observational study comprising 60 selected cone-beam computed tomography (CBCT) scans that were divided into four groups (n = 15) according to the degree of septal deviation and skeletal maturation: mild deviation (MD; <10°), moderate to severe deviation (MSD; ≥10°), early group (EG), and late group (LG). The angle and area of deviation were measured for the greatest NSD, and a geometric morphometric approach was used to evaluate the nasal septum (NS) shape. The morphology of the nasomaxillary complex and the presence of fluctuating asymmetries were evaluated using 23 two-dimensional landmarks on the nasomaxillary complex (nasal, lateral, and palatal regions) with Procrustes ANOVA and Mann-Whitney test. Additionally, Spearman's correlation and multivariate regression were used to correlate the NSD with asymmetries in these regions. No significant differences were observed in the Procrustes FA scores of the nasomaxillary complex between the MD-EG × MSD-EG and MD-LG × MSD-LG (p > 0.05). However, the results of the multivariate regression revealed more specific aspects of asymmetry (asymmetry component), there was a positive correlation between the NSD angle and the palatal regions (p = 0.035 and p = 0.047, middle and posterior, respectively), and the nasal septum shape and anterior palatal regions (p = 0.039). The nasal and lateral regions did not correlate with the NSD angle in the multivariate regression analysis (p > 0.05). The results of this study indicate that there were no significant differences in the fluctuating asymmetry of the nasomaxillary complex between the mild and moderate to severe nasal septum deviation groups, in both early and late skeletal maturation stages. However, a positive correlation was observed in the degree of nasal septum deviation angle and asymmetry components of the middle and posterior palatal regions, likewise between the nasal septum shape and asymmetry components of the anterior palatal region. The diagnosis of nasal septum deviation by both physicians and dentists is important, as a relationship was observed with fluctuating asymmetry component of the palatal region. This information can guide the decision of the treatment planning for these individuals, and should be considered, especially in cases of severe septum deviation, due to the great anatomical proximity of these structures.

Evaluation of the relationship between nasal septal deviation and development of facial asymmetry with anthropometric measurements depending on age

AIM

It was aimed to determine the change of facial asymmetry resulting from nasal septal deviation (SD) depending on age, gender, degree of deviation and the affected area besides the effect of SD on somatotype and craniofacial morphology.

MATERIALS AND METHODS

171 volunteers (90 males, 81 females), 27 individuals aged 9-13, 44 individuals aged 14-18, 44 individuals aged 19-23 and 56 individuals in control group participated in the study conducted in otorhinolaryngology polyclinic.11 photometric, 16 anthropometric measurements were taken from the participants.

RESULTS

SD affects facial asymmetry formation, although not statistically significant compared to healthy individuals asymmetry rates (p˃0.05). It was determined that the degree of SD affected asymmetry only between the ages of 14-18 (in adolescence) and the development of asymmetry in all SD patients was not statistically dependent on age and gender (p˃0.05). Photometric measurements demonstrated asymmetries in horizontally-extending parameters of 1/3 middle part of face. There was no statistically significant difference in the cranial anthropometric measurements of the upper and lower 1/3 of the face compared to the control group (p˃0.05). The order of the most asymmetrical parameters is Alare-Zygion, Alare-Subnasale, Cheilion-Gonion, Exocanthion-Cheilion, Midsagittal plane-Zygion, Zygion-Cheilion, Zygion-Gonion, Subalare-Cheilion, Glabella-Exocanthion. In all participants were determined that endomorph somatotype was dominant in female and mesomorph somatotype was dominant in male besides SD did not affect somatotype and somatotype did not alter with age.

CONCLUSION

The development of facial asymmetry due to SD is not affected by age and gender furthermore SD does not affect craniofacial asymmetry and somatotype.

Prevalence of Facial Asymmetry and Correction Methods for Rhinoplasty in Individuals with Deviated Nose: A Brief Review

Background:

Surgeons frequently perform rhinoplasty on individuals who have facial asymmetry. Patients’ discontent following rhinoplasty has been linked to facial asymmetry. On the other hand, correction of a deviated nose is a tough procedure, and it is not the same as septal deviation correction. Surgeons, who often perform rhinoplasty for deviated nose in people with asymmetrical faces, focus primarily on correcting nasal defects and overlook such facial asymmetry.

Aim:

We aimed to summarize and review the prevalence of facial asymmetry in patients subjected for rhinoplasty for deviated nose correction.

Methods:

A systematic search was conducted covering PubMed, Scopus, ISI, and Google Scholar using related key words and MeSH (Medical Subject Headings) terms from 2000 until November 2021 for English published articles.

Results:

The majority of subjects had more facial asymmetry such as chin deviation, nasal deviation, and face breadth. Facial asymmetry is typically found in patients undergoing rhinoplasty for a deviated nose, and its presence frequently results in the failure to achieve a straight-looking nose.

Conclusion:

Patients considering rhinoplasty frequently have facial asymmetries, and careful attention should be devoted to these elements in both surgical planning and patient counseling. In order to create facial harmony and apparent symmetry after rhinoplasty, it is critical to center the nose on the midglabellar to mid–bow Cupid’s line.

Effect of septal deviation on nasomaxillary shape: A geometric morphometric study

Nasal cavities in their primitive stage communicate with the oral cavity until the 8th week of intrauterine life where the posterior palate initiates its development. Hence, starting from the initial growth phases, a significant connection lays between the nasal structures and the maxillary bone and witnessing key functional roles, among which the respiration. Proper nasal breathing has been proven to be a crucial factor for the maturity of the craniofacial complex, and obstruction of the respiratory airway due to nasal septum deviation can generate clinically significant reduction of the nasal airflow. This situation will imply irreversible repercussions that hinders the harmonious development of the craniofacial complex. In order to understand such potential impacts of septal deviation, our first objective was to materialize the relation between septum deviation, and both nasal cavity and maxillary structures. For the second objective, we used Procrustes analysis to assess the shape variation of these two anatomical regions, the bivariate plots of Principal Components to evaluate their shape space, and a two-block Partial Least Square (PLS) to explore their covariation. We analysed, in this cross-sectional study, 62 posteroanterior cephalometric radiographs of adult subjects from both sexes (23 males, 39 females; mean age 25.3 years) collected from the database of the Department of Orthodontics at Lebanese University. Landmarks were plotted and variables were calculated and divided into nasal septum, nasal cavity and maxillary ones. The sample was further divided into two groups based on septal deviation severity (a septal deviation is considered minor if <6). The results suggested that nasal septum deviation was correlated to reduced nasal cavity area and a reduced maxillary area. Moreover, the comparison of the two groups concluded that the difference between all variables was statistically significant with higher scores in the minor septal deviation group. These findings were corroborated with the shape analysis where the mean centroid size of nasal cavity and that of the maxilla in the group of reduced septal deviation were significantly greater than those of the group with increased angle of deviation. Results of PLS analysis concluded to a strong covariation between nasal septum and nasomaxillary complex. These conclusions support the early septoplasty in growing patients as a solution to redirect the normal course of growth and re-establish a good function of the nasomaxillary complex.

How Deviation of Nasal Septum Affects Nasal Appearance in Unilateral Cleft Patients: A Study Using Cone-Beam Computed Tomography

AIM

To quantitatively evaluate the relationship between nasal appearance and nasal septum deviation in unilateral complete cleft patients using cone-beam computed tomography.Method: Cone-beam computed tomography images of 180 patients with unilateral cleft lip/palate from June 2014 to June 2017 were used in the study. None of the subjects had undergone septoplasty. The data were compared between the 2 groups to elucidate the relationship between nasal appearance and deviated nasal septum in unilateral complete cleft patients.

RESULTS

The mean age of a total of 180 patients (126 males and 54 females) was 14.58 years, with a standard deviation of 7.10 years, ranged from 6 years old to 49 years old. Columella nasi symmetry parameters show slight positive significant association with angle of nasal septal deviation on transerve plan (r = 0.250, P < 0.001), TRSD (r = 0.323, P < 0.001) and coronal range of nasal septal deviation (r = 0.294, P < 0.001), and moderate positive significant association with coronal angle about septal deviation (r = 0.404, P < 0.001).

CONCLUSIONS

Columella nasi symmetry affected by septal deviation, whereas there is lack of evidence to say symmetry of nasal tip and base affected by septal deviation. The symmetry of nasal tip and alar base are not just determined by nasal septum deviation. The nasal septum deviation show difference in different cleft type.

The Impact of Facial Asymmetry on the Surgical Outcome of Crooked Nose: A Case Control Study

BACKGROUND

Facial asymmetry is considered a reason for patient dissatisfaction with the outcome of rhinoplasty.

OBJECTIVES

The aim of this study was to evaluate the impact of facial asymmetry on patient postoperative satisfaction with crooked nose and to investigate the relationship between visual perception of asymmetry and anthropometric measurements.

METHODS

In this retrospective study, 61 rhinoplasty patients with crooked noses were assessed. Utilizing frontal view photos, pre- and postoperative nasal deviation angles were calculated. The patients were divided into 2 groups based on the visual presence of facial asymmetry. Moreover, anthropometric characteristics of the face were evaluated utilizing facial soft tissue landmarks. Patient satisfaction with surgery outcomes, including both aesthetic and functional aspects, was assessed employing the Persian version of the Standardized Cosmesis and Health Nasal Outcomes Survey.

RESULTS

Based on the observations, 19 (30.2%) and 44 (69.8%) patients had I-type and C-type noses, respectively. In both groups, the deviation angle decreased significantly postoperatively (P < 0.001). Regarding the subjective evaluation of facial asymmetry, 22 (34.9%) and 41 (65.1%) cases had symmetric and asymmetric faces, respectively. Anthropometric measurements were also consistent with visual assessments of asymmetry. Satisfaction scores were significantly higher after surgery in all patients; however, there was no significant difference in the mean aesthetic improvement between symmetric (15.83 ± 2.68) and asymmetric faces (15.23 ± 4.46) (P = 0.531). The power of study was 97.8%.

CONCLUSIONS

Rhinoplasty in patients with deviated noses and asymmetric faces may have comparable results with symmetric ones.

LEVEL OF EVIDENCE: 4

Nasal septal deviation in the unilateral cleft lip and palate deformities: a three-dimensional analysis

OBJECTIVES

Lip and palate deformities are an important craniofacial congenital anomaly that negatively affects the anatomy of the nasal cavity and maxilla. This study aimed to evaluate the nasal septum deviation in individuals with a unilateral cleft lip and palate.

METHODS

The sample consists of 22 unilateral cleft lip-palate patients and 20 controls with non-cleft skeletal Class III. Maximal septal deviation angle and linear dimension were measured on cone-beam computed tomography images. The localization of maximal septal deviation was determined. The data were analyzed and compared between unilateral cleft lip-palate patients and skeletal Class III individuals.

RESULTS

For septal deviation, a significant discrepancy between unilateral cleft patients and skeletal Class III subjects was detected at the anterior nasal spine (ANS) level, the posterior nasal spine (PNS) level and the ANS-PNS midpoint level (p < 0.05). The maximum septal deviation angle of individuals with a unilateral cleft was significantly greater than individuals with skeletal Class III (p < 0.05). No statistically significant differences were found in the localization of maximum septal deviation between the unilateral cleft patients and the Class III individuals.

CONCLUSION

Our results demonstrated that the maximum septal deviation angle and dimension had significant differences in individuals with a unilateral cleft, compared to a skeletal Class III control group. However, no statistically significant discrepancy was observed between three levels (ANS, PNS and ANS-PNS middle levels) in the unilateral cleft patients.

Relationship between nasal septum morphology and nasal obstruction symptom severity: computed tomography study

Introduction

The impact of the nasal septum morphology on the severity of obstruction symptoms has not been fully explored.

Objective

This study aimed to investigate whether the morphology of the deviated nasal septum assessed by computed tomography may explain nasal obstruction severity.

Methods

The study included 386 patients who were referred to the computed tomography examination of the paranasal sinuses. Patient selection criteria were the absence of facial anomalies, facial trauma, nasal surgery, and sinonasal tumors. Computed tomography images were used to estimate deviated nasal septum prevalence, the prevalence of Mladina's seven types of deviated nasal septum, and to measure the deviated nasal septum angle. Nasal obstruction severity was assessed by the nasal obstruction symptom evaluation, NOSE scale. The relationship between NOSE score, deviated nasal septum morphology, and deviated nasal septum angle was performed by a statistical regression model on the reduced sample of 225 patients.

Results

The prevalence of deviated nasal septum was 92.7%. Type 7 deviated nasal septum was the most frequent (34.2%) followed by type 5 (26.2%) and type 3 (23.6%). The worst NOSE scores were recorded in the type 2 deviated nasal septum (45.00 ± 28.28). The mean deviated nasal septum angle in patients with nasal obstruction was 8.5° ± 3.24. NOSE scores were not significantly associated with deviated nasal septum types and angles.

Conclusion

Patients with different types of deviated nasal septum have different NOSE scores. Computed tomography morphology of the deviated nasal septum could not fully explain the severity of nasal obstruction.

Rigging the nose: a pilot study using barbed sutures in patients with deviated nose

Background

A deviated nose is a very common developmental feature in Caucasian populations and represents a frequent indication for rhinoplasty, either functional or esthetic. We aim to assess the pattern of nasal axis stabilization after rhinoplasty in the deviated nose on the basis of anthropometric measurements: median face axis (MFA), interpupillary meridian axis (IMA), and scoliosis angle (SA); to study possible effects of rigging the nose in the midfacial soft tissues using absorbable soft sutures; to investigate possible side effects.

Methods

Seventy patients with a non-traumatic deviated nose (n = 50 as control group, n = 20 as treated group with placement of barbed suture in the midfacial soft tissues) underwent rhinoplasty procedures. We retrospectively examined the pattern of deviation recurrence over time in a consecutive series of 70 non-traumatic patients undergoing primary esthetic or functional rhinoplasty (n = 50 as control group, n = 20 as treated group with placement of barbed suture in the midfacial soft tissues). Patients were followed up at 1 week, 2 weeks, 1 month, 3 months, and 1 year postoperatively.

Results

Ninety-three percent (65/70) of the patients had an asymmetric face after comparing the two anthropometric angles MFA and IMA. Overcorrection of NA at one week postoperatively was observed in 1.25% and 35.7% of patients in the control and treated groups, respectively (p = 0.006). MFA shifted from 4.16° ± 3.1° preoperatively to 1.2° ± 1.4° at 1 week, 1.0° ± 1.1° at 2 weeks, 1.1° ± 1.4° at 1 month, 1.1° ± 1.5° at 3 months, and 1.7° ± 2° at 1 year in the control group. In the treated group, MFA shifted from 5.7° ± 2.9 preoperatively to − 0.34° ± 2.9° at 1 week, 1.0° ± 1.1° at 2 weeks, 0.59° ± 0.96° at 1 month, 1.22° ± 0.83° at 3 months, and 1.63° ± 0.8° at 1 year. Differences between the groups were significant at 1 week (p = 0.02), but differences were not significant at 2 weeks, 1 month, 3 months, and 1 year.

Conclusions

This pilot study demonstrates that the progressive re-deviation pattern is altered during the first weeks after surgery in the barbed sutures group. Absorbable barbed sutures in facial soft tissues are well tolerated. Longer lasting sutures may help to obtain definite advantage.

Level of evidence: Level IV, therapeutic study.

Comparison of Inferior Turbinate and Uncinate Process Angulation with Normal Population in Patients with Septal Spur

The presence of septal spur may cause various pathologies by affecting the development of the inferior turbinate, osteomeatal unit and uncinate process. We aimed to compare the changes of the angle with inferior turbinate and the maxillary medial wall of the uncinate process in patients with septal spur by normal population. In the study, 138 patients with septal spur and unilateral septum deviation and 83 patients without septum deviation were evaluated retrospectively. The angles of the inferior turbinate and the uncinate process with the medial wall of the maxilla were measured at the ostemaetal unit level. The changes of the inferior turbinate and the uncinate process with the maxilla medial wall compared to the opposite side of the deviated side and the normal population were compared. Angle of the inferior turbinate with the medial wall of the maxilla is significantly smaller in the side with septum deviation to the side without septum deviation and normal population and significantly large in the side without septum deviation to normal population. Angle of the uncinate process with the medial wall of the maxilla is significantly large in the side with septum deviation to the side without septum deviation and normal population and significantly smaller in the side without septum deviation to normal population. Presence of septum base crest are thought to cause structural changes at the inferior turbinate and the uncinate process. We recommend to break the inferior turbinate at the concave side in patients with basal crest.

Is Computed Tomography Imaging of Deviated Nasal Septum Justified for Obstruction Confirmation?

Third-party payers request objective confirmation of the nasal septum deviation (NSD) severity by computed tomography (CT) before authorizing financial support for septoplasty. Previous studies have provided contradictory results related to the link between obstruction severity and CT-measured angle of the NSD. The aim of this study was to investigate whether the diverse CT morphology of NSDs (including previously neglected types and shapes) could predict obstruction severity. The study included 225 patients with NSD. The CT morphology of the septum was analyzed using 5 different classifications of NSD that are commonly used in the clinical practice and research. The angle of NSD was also measured. Nasal obstruction was assessed by the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire. A relationship between CT morphology and the angle of the NSD and NOSE scores was analyzed using appropriate regression models. Patients with NSDs located in the anterior part of the septum always have some degree of nasal obstruction, while those with posterior NSDs did not necessarily report obstruction symptoms no matter how complicated NSD they have. Regression analysis did not reveal any causal relationship between NOSE scores and CT morphology and the angle of NSD. The presence of spurs and whether they divide nasal passages have no statistically significant predictive effect on the obstruction severity. The CT morphology and the angle of the NSD could not predict severity of the nasal obstruction. Requesting CT examination just to objectively confirm nasal obstruction is not justified.

Orientation of the premaxilla in the origin of septal deviation

INTRODUCTION

While most people believe the nasal septum to have intrinsic deviation and overgrowth in patients seeking rhinoplasty, an alternative concept is that a mal-oriented premaxilla causes extrinsic septal buckling and external extrusion of the septal cartilage. In this sense, the premaxillary bone plays a significant role in the pathogenesis of septal deviation. This study was performed to determine if non-traumatically acquired septal/nasal functional and aesthetic pathology or septal deviation may be related to the orientation of the premaxilla relative to the skullbase.

METHODS

A retrospective, single-center study of patients in the general population who underwent maxillofacial CT scans and presented for the evaluation of nasal obstruction. CT scans were used to measure features of both pathologic and non-pathologic nasal septums.

RESULTS

A total of 68 subjects were evaluated. When comparing patients with a premaxillary-skullbase angle of greater than 81° (the mean of the study group) to those of less than 81°, and a more obtuse nasolabial angle was observed (p = 0.0269). When comparing the extremes of premaxillary rotation, specifically, greater than 87° (mean 91.7°, SD 5.1) and less than 77° (mean 70.7°, SD 3.6), the differences were more pronounced with regard to caudal septal excess (p = 0.0451) and septal deviation in the axial plane (p = 0.0150).

CONCLUSION

Septal developmental changes may involve an overly rotated or more vertically oriented premaxillary bone relative to the skull base. An understanding of the cause of septal deformity may provide insight into the design of improved treatments.

Morphological interaction between the nasal septum and nasofacial skeleton during human ontogeny

The nasal septal cartilage is thought to be a key growth center that contributes to nasofacial skeletal development. Despite the developmental influence of the nasal septum however, humans often exhibit a high frequency of septal deviation suggesting discordance in the growth between the septum and surrounding nasofacial skeleton. While there are numerous etiological factors that contribute to septal deviation, the surrounding nasofacial skeleton may also act to constrain the septum, resulting in altered patterns of growth. That is, while the nasal septum has a direct morphogenetic influence on aspects of the nasofacial skeleton, other nasofacial skeletal components may restrict septal growth resulting in deviation. Detailing the developmental relationship between these structures is important not only for understanding the causal determinants of nasal septal deviation, but also for developing a broader understanding of the complex interaction between the facial skeleton and chondrocranium. We selected 66 non-syndromic subjects from the University of Minnesota Orthodontic Clinic who ranged from 7 to 18 years in age and had an existing pretreatment cone-beam computed tomography (CBCT) scan. Using CBCT data, we examined the developmental relationship between nasal septal deviation and the surrounding nasofacial skeleton. We measured septal deviation as a percentage of septal volume relative to a modeled non-deviated septum. We then collected a series of coordinate landmark data in the region immediately surrounding the nasal septum in the midsagittal plane representing the nasofacial skeleton. First, we examined ontogenetic changes in the magnitude of nasal septal deviation relative to chronological age and nasofacial size. Next, using Procrustes-based geometric morphometric techniques, we assessed the morphological relationship between nasal septal deviation and nasofacial skeletal shape. Our results indicate that variation in the magnitude of nasal septal deviation was established in our earliest age group and maintained throughout ontogeny. Moreover, nasal septal deviation was correlated with non-allometric variation in nasofacial shape restricted to the region of the anterior sphenoid body. Ultimately, our results suggest that early developmental variation in midline basicranial components may act to alter or constrain patterns of nasal septal growth.

The Relationship Between Facial Asymmetry and Nasal Septal Deviation

PURPOSE

Facial asymmetry is not uncommon in normal individuals. Nasal septum is known to play a direct and indirect role in the premaxillary and maxillary growth. In this study, we aimed to evaluate the integrated relationship between nasal septal deviation and facial asymmetry by means of 3-dimensional analysis in a larger number of patients than those in previous studies.

METHODS

From April 2011 to March 2014, a total of 60 subjects were included. They had facial asymmetry confirmed by facial three-dimensional CT. Patients who had a history of facial bone fracture or congenital craniofacial deformities were excluded. Facial asymmetry was analyzed in 3 aspects: facial width, projection, and height. Nasal septal deviations included horizontal and vertical deviations.

RESULTS

The patients with right horizontal nasal septal deviation to the right had a wider right side of the face (P = 0.028). Facial asymmetry was observed more frequently in the right side of the face in the current study (P = 0.020). There were no other close relationships between nasal septal deviation and facial asymmetry.

CONCLUSION

We demonstrate that there is a strong relationship between nasal septal deviation to the right and a wider right hemiface in facial asymmetry patients. Also, facial asymmetry patients tend to have a wider right side of the face compared to the left side.

Association of facial asymmetry and nasal septal deviation in acquired nasolacrimal duct obstruction in East Asians

PURPOSE

The objective of this study was to evaluate the association of facial asymmetry and nasal septal deviation in acquired unilateral nasolacrimal duct (NLD) obstruction.

METHODS

A retrospective survey was conducted of 39 patients (6 male and 33 female) who had undergone endoscopic dacryocystorhinostomy at the Korea University Ansan Hospital. Patients with trauma to the orbit or any known lacrimal duct disease were excluded. The primary goal was to obtain a descriptive analysis of facial asymmetry and nasal septal deviation. We analyzed the results and identified associations with facial asymmetry and nasal septal deviation in NLD obstruction and determined the influence of the degree of asymmetry and deviation on the results.

RESULTS

The mean length of the straight line drawn from the lateral canthus to the corner of the mouth was 10.2 cm in the right eye and 9.9 cm in the left eye, and the difference was statistically significant by the Wilcoxon signed rank test (P = 0.043). The laterality of NLD obstruction corresponded to the smaller side of the face in 27 of 39 patients (P = 0.038, κ = 0.753 by cross-table McNemar test). Also, a significant positive linear relation of correspondence of NLD obstruction to the smaller side of the face was observed according to the degree of facial asymmetry (P = 0.043 by linear-by-linear association). Nasolacrimal duct obstruction appeared to occur on the side in which the nasal septum was deviated in 25 of 39 patients (P = 0.043, κ = 0.652 by cross-table McNemar test). Significant positive linear relation of correspondence of NLD obstruction to the side in which the nasal septum was deviated was also observed according to the degree of nasal septal deviation (P = 0.045 by linear-by-linear association). There is also a trend of nasal septal deviation toward the smaller side of the face (total 25 of 39 patients, P = 0.043 by cross-table McNemar test).

CONCLUSIONS

Unilateral NLD obstruction appears to occur on the side in which the nasal septum is deviated, and nasal septal deviation tends to be toward the smaller side of the face. Also, the degree of facial asymmetry and nasal septal deviation may affect NLD obstruction. This study showed that facial asymmetry and nasal septal deviation could be a cause of unilateral NLD obstruction. This finding can aid in differentiating lacrimal duct obstruction, especially when combined with physical examination.

Consistent ipsilateral development of the posterior extension of the quadrangular cartilage and bony spur formation in nasal septal deviation

OBJECTIVE

Septal spurs are exceedingly common structural deformities that contribute to nasal obstruction and often require surgical correction. The posterior extension of the quadrangular cartilage (PEQC) and its relationship with septal spurs have not been previously examined. We seek to examine the anatomic and histologic relationship of the PEQC and concurrent septal spurs in patients undergoing septoplasty.

STUDY DESIGN

Prospective cohort study.

SETTING

Facial plastic and rhinology center in tertiary hospital setting.

SUBJECT AND METHODS

Thirty patients with septal deviation are described in this series. The quadrangular cartilage and associated septal spur were removed en bloc from patients undergoing septoplasty. The length of the PEQC, the side of spur deviation, and the relationship of the PEQC to the spur (ipsilateral vs contralateral) were recorded.

RESULTS

The mean length of the PEQC, beyond the bony-cartilaginous junction, was 30.06±6.06 mm. The PEQC was present on the ipsilateral side of the spur deviation in all 30 patients (100%).

CONCLUSION

At sites of septal spur formation, the quadrangular cartilage possesses an average 3-cm extension beyond its junction with the bony components of the septum. This cartilaginous extension is exclusively found on the same side of spur deviation. These findings have implications on our understanding of the ontogeny of commonly found septal spurs and deviations, as well as treatment strategies and cartilage graft harvesting.

Analysis of Nasal Septal Deviation in Cleft Palate and/or Alveolus Patients Using Cone-Beam Computed Tomography

OBJECTIVE

This study was performed to analyze features of nasal septal deviation of patients with different cleft types and noncleft controls.

STUDY DESIGN

Case-control study.

SETTING

West China Hospital of Stomatology, Chengdu, China.

SUBJECTS AND METHODS

Sixty-six patients with palatal and/or alveolar cleft and 42 noncleft controls were recruited in the study. All the subjects have undergone cone-beam computed tomography scan. The range, angle, vertical location, and convex direction of nasal septal deviation were carefully studied for each subject. The data were compared between the cleft group and noncleft controls. The differences of deviation among various cleft types were also carefully evaluated to demonstrate whether the differences in cleft types affect the features of nasal septal deviation.

RESULTS

The mean range 7.71 mm and angle 10.37° of nasal septal deviation in cleft group were significantly greater than that in control group of 1.96 mm and 2.34°. The maximum point of nasal septal deviation in cleft group vertically occurred more often at inferior turbinate level (27/66) followed by lower inter-turbinate level (16/66) and middle turbinate level (11/66). Patients with complete cleft palate presented greater deviation than incomplete cleft palate or simple cleft alveolus patients. The convex direction of deviation was to the cleft side for all patients with complete cleft palate or simple alveolar cleft.

CONCLUSION

Patients with cleft palate and/or alveolus presented greater deviation of nasal septum than noncleft controls. Patients of different cleft types showed various severity and features of nasal septal deviation.

Assessment of the relationship between palatum durum and maxillary bone in patients with nasal polyp, chronic sinusitis or septum deviation

Nasal obstruction most commonly occurs due to mucosal abnormalities and those in cartilage-bone structure such as nasal polyp, septum deviation, concha hypertrophy and chronic sinusitis in adults. Adenoid vegetation is the most prominent cause in childhood. In the present study, we aimed to investigate whether maxillary and palatal bone developments continue in patients with abnormalities causing nasal obstruction. As computerized tomography is the optimal imaging modality in nasal cavity abnormalities, CT scan findings of patients with Control nasal polyp, chronic sinusitis and septum deviation were retrospectively evaluated; and palatal curve changes were compared. In our study, it was found that maxillary bone curve was widened in adult patients with nasal polyp; this angle was further narrowed in those with chronic sinusitis; and maxillary bone curve narrowing and increase in the distance to palatal bone was smaller in patients with septum deviation than those in chronic sinusitis. In the light of these findings, we concluded that, in adults, maxillary and palatal bone developments continue in certain circumstances including nasal polyp, chronic sinusitis or septum deviation.

Rhinoplasty and facial asymmetry: Analysis of subjective and anthropometric factors in the Caucasian nose

INTRODUCTION

 Anthropometric proportions and symmetry are considered determinants of beauty. These parameters have significant importance in facial plastic surgery, particularly in rhinoplasty. As the central organ of the face, the nose is especially important in determining facial symmetry, both through the perception of a crooked nose and through the determination of facial growth. The evaluation of the presence of facial asymmetry has great relevance preoperatively, both for surgical planning and counseling.

AIM/OBJECTIVE

 To evaluate and document the presence of facial asymmetry in patients during rhinoplasty planning and to correlate the anthropometric measures with the perception of facial symmetry or asymmetry, assessing whether there is a higher prevalence of facial asymmetry in these patients compared to volunteers without nasal complaints.

METHODS

 This prospective study was performed by comparing photographs of patients with rhinoplasty planning and volunteers (controls), n = 201, and by evaluating of anthropometric measurements taken from a line passing through the center of the face, until tragus, medial canthus, corner side wing margin, and oral commissure of each side, by statistical analysis (Z test and odds ratio).

RESULTS

 None of the patients or volunteers had completely symmetric values. Subjectively, 59% of patients were perceived as asymmetric, against 54% of volunteers. Objectively, more than 89% of respondents had asymmetrical measures. Patients had greater RLMTr (MidLine Tragus Ratio) asymmetry than volunteers, which was statistically significant.

DISCUSSION/CONCLUSION

 Facial asymmetries are very common in patients seeking rhinoplasty, and special attention should be paid to these aspects both for surgical planning and for counseling of patients.