Impact of Nasal Septum Deviation on Maxillomandibular Morphology and Nasal Volume: A Retrospective Computed Tomography Study
Abstract
Objectives
This study aimed to investigate the association between nasal septum deviation (NSD) and the development of maxillomandibular structures and nasal morphology.
Materials and Methods
Computed tomography (CT) scans of 337 patients (mean age: 34.9 ± 10.95 years) were analyzed to assess the realtionship between NSD, transverse maxillary/mandibulary dimensions, and nasal volume. Measurements included 4 maxillary and 1 mandibular landmarks: Anterior nasal spina-posterior nasal spina (ANS-PNS) length, maxillary width, maxillary height (distance from Mx-Mx line to orbital floors), maxillary depth (distance from the first molar cemento-enamel junction to nasal floor), mandibular width (the distance between the outermost points of mandibular left and right first permanent molar). NSD presence was classified using Mladina’s system. Student’s t-test compared measurements based on NSD presence, while ANOVA assessed differences among NSD types. Statistical significance was set at p<0.05.
Results
Among participants, 44 (13.1%) had no nasal septal deviation (NSD). The prevalence of NSD types was as follows: Type I (21.1%), Type II (10.7%), Type III (16.6%), Type IV (7.4%), Type V (10.1%), Type VI (14.8%), and Type VII (6.2%). Comparison between patients with and without NSD showed no statistically significant differences in ANS-PNS distance, maxillary width, maxillary height, maxillary nasal base height, or mandibular molar width (p > 0.05). Males exhibited significantly larger craniofacial parameters and nasal volume than females. Maxillary width in patients aged 16 and older was significantly smaller than the value reported by Ricketts (p < 0.05). Nasal volume increased in the presence of NSD (p=0.01).
Conclusions
While NSD is a common condition, its impact on maxillomandibular development remains uncertain. However, its presence is associated with an increase in nasal volume. Further research incorporating larger sample sizes, advanced volumetric analyses, and functional assessments is essential to comprehensively evaluate the relationship between NSD and maxillomandibular morphology.
Keywords: nasal septum, maxilla, mandible, nasal obstruction, cone-beam computed tomography
ÖZET
Amaç:
Bu çalışmanın amacı, nazal septum deviasyonu (NSD) ile maksillomandibular ve nazal gelişim arasındaki ilişkiyi araştırmaktır.
Gereç ve Yöntemler:
Çalışmada, 337 hastanın (ortalama yaş: 34,9 ± 10,95 yıl) paranazal bilgisayarlı tomografi (BT) görüntüleri kullanılarak NSD ile maksiller/mandibular transvers parametreler ve nazal hacim arasındaki ilişki analiz edilmiştir. Ölçümler 4 maksiller ve 1 mandibular anatomik noktayı içermektedir: Anterior nazal spina-posterior nazal spina (ANS-PNS) uzunluğu, maksiller genişlik, maksiller yükseklik (Mx-Mx hattından orbitaların tabanına olan mesafe), maksiller derinlik (birinci molar bölgesindeki sement-mine birleşiminden nazal tabana olan mesafe) ve mandibular genişlik (sol ve sağ mandibular birinci moların en dış noktaları arasındaki mesafe). NSD varlığına göre ölçümleri karşılaştırmak için Student’s t-testi uygulanmıştır. Farklı NSD tiplerine bağlı parametre farklılıkları ANOVA testi ile değerlendirilmiştir. İstatistiksel anlamlılık seviyesi olarak p<0,05 kabul edilmiştir.
Bulgular:
Toplam 44 hastada (%13,1) NSD saptanmamıştır. Mladina sınıflamasına göre NSD tiplerinin dağılımı şu şekilde bulunmuştur: Tip I (%21,1), Tip II (%10,7), Tip III (%16,6), Tip IV (%7,4), Tip V (%10,1), Tip VI (%14,8) ve Tip VII (%6,2). NSD bulunan ve bulunmayan hastalar karşılaştırıldığında, ANS-PNS mesafesi, maksiller genişlik, maksiller yükseklik, maksiller nazal taban yüksekliği ve mandibular molar genişlik açısından istatistiksel olarak anlamlı bir fark saptanmamıştır (p > 0,05). Erkek hastalarda, kadınlara kıyasla kraniyofasiyal parametreler ve toplam nazal hacim anlamlı derecede daha büyük bulunmuştur. 16 yaş ve üzeri hastalarda maksiller genişlik, Ricketts tarafından bildirilen değerlerden daha küçük bulunmuştur. NSD varlığında nazal hacimde artış gözlenmiştir (p=0.01)
Sonuçlar:
NSD yaygın bir durum olmakla birlikte, kraniyofasiyal gelişim üzerindeki etkisi belirsizliğini korumaktadır. NSD, maksiller ve mandibular temel boyutları anlamlı şekilde değiştirmemekle birlikte, nazal hacimde artışla ilişkilidir. NSD ve maksillomandibular morfoloji arasındaki ilişkiyi kapsamlı bir şekilde değerlendirebilmek için daha geniş örneklem grupları, ileri hacim analizleri ve fonksiyonel değerlendirmeler içeren ek çalışmalara ihtiyaç vardır.
• Anahtar Kelimeler: Nazal septum, maksilla, mandibula, nazal tıkanıklık, konik ışınlı bilgisayarlı tomografi
Project Number
Not applicable
References
- 1. Mladina R, Čujić E, Šubarić M, Vuković K. Nasal septal deformities in ear, nose, and throat patients: an international study. Am J Otolaryngol 2008;29:75-82.
- 2. Koo SK, Kim JD, Moon JS, Jung SH, Lee SH. The incidence of concha bullosa, unusual anatomic variation and its relationship to nasal septal deviation: A retrospective radiologic study. Auris Nasus Larynx 2017;44:561-570.
- 3. Yildirim I, Okur E. The prevalence of nasal septal deviation in children from Kahramanmaras, Turkey. Int J Pediatr Otorhinolaryngol 2003;67:1203-1206.
- 4. Stallman JS, Lobo JN SP. The Incidence of Concha Bullosa and Its Relationship to Nasal Septal Deviation and Paranasal Sinus Disease. Am J Neuroradiol 2004;25:1613-1618.
- 5. Moss ML, Salentijn L. The primary role of functional matrices in facial growth. Am J Orthod 1969;55:566-577.
- 6. Linder Aronson S. Effects of adenoidectomy on mode of breathing, size of adenoids and nasal airflow. ORL J Otorhinolaryngol Relat Spec 1973;35:283-302.
- 7. Pereira SRA, Bakor SF, Weckx LLM. Adenotonsillectomy in facial growing patients: spontaneous dental effects. Braz J Otorhinolaryngol 2011;77:600-604.
- 8. D’Ascanio L, Lancione C, Pompa G, Rebuffini E, Mansi N, Manzini M. Craniofacial growth in children with nasal septum deviation: A cephalometric comparative study. Int J Pediatr Otorhinolaryngol 2010;74:1180-1183.
- 9. Akbay E, Cokkeser Y, Yilmaz O, Cevik C. The relationship between posterior septum deviation and depth of maxillopalatal arch. Auris Nasus Larynx 2013;40:286-290.
- 10. Fabiana B, Alberto B, Salvatore R, Alessandro N, Paola C. Is there a correlation between nasal septum deviation and maxillary transversal deficiency? A retrospective study on prepubertal subjects. Int J Pediatr Otorhinolaryngol 2016;83:109-112.
- 11. Mladina R, Čujić E, Šubarić M, Vuković K. Nasal septal deformities in ear, nose, and throat patients: an international study. Am J Otolaryngol 2008;29:75-82.
- 12. Kim H-Y. Statistical notes for clinical researchers: Evaluation of measurement error 2: Dahlberg’s error, Bland-Altman method, and Kappa coefficient. Restor Dent Endod 2013;38:182.
- 13. Anderson PJ, Yong R, Surman TL, Rajion ZA, Ranjitkar S. Application of three-dimensional computed tomography in craniofacial clinical practice and research. Aust Dent J 2014;59:174-185.
- 14. Codari M, Zago M, Guidugli GA, Pucciarelli V, Tartaglia GM, Ottaviani F, Righini S, Sforza C. The nasal septum deviation index (NSDI) based on CBCT data. Dentomaxillofacial Radiol 2016;45:20150327.
- 15. Periyasamy V, Bhat S, Sree Ram MN. Classification of naso septal deviation angle and its clinical implications: a ct scan imaging study of palakkad population, india. Indian J Otolaryngol Head Neck Surg 2018;71:2004.
- 16. Kawalski H, Śpiewak P. How septum deformations in newborns occur. Int J Pediatr Otorhinolaryngol 1998;44:23-30.
- 17. Ozturk EMA, Yalcin ED. Examination of the relationship between concha bullosa with nasal septum deviation and maxillary sinus pathologies using cone-beam computed tomography. Cumhur Dent J 2022;25:19-23.
- 18. Ahn JC, Kim JW, Lee CH, Rhee CS. Prevalence and risk factors of chronic rhinosinusitus, allergic rhinitis, and nasal septal deviation: results of the korean national health and nutrition survey 2008-2012. JAMA Otolaryngol Head Neck Surg 2016;142:162-167.
- 19. Janovic N, Janovic A, Milicic B, Djuric M. Relationship between nasal septum morphology and nasal obstruction symptom severity: computed tomography study. Braz J Otorhinolaryngol 2022;88:663-668.
- 20. Bektaş B, Buyuk SK, Benkli YA, Ozkan S. Nazal septum deviasyonlarinin iskeletsel ve dental etkilerinin postero-anterior radyograflarla değerlendirilmesi. Atatürk Üniv Diş Hek Fak Derg 2016;26(1):73-78.
- 21. Fabiana B, Alberto B, Salvatore R, Alessandro N, Paola C. Is there a correlation between nasal septum deviation and maxillary transversal deficiency? A retrospective study on prepubertal subjects. Int J Pediatr Otorhinolaryngol 2016;83:109-112.
- 22. Ganesan P, Golla UR, Balashanmugam B, Munuswamy GL. Evaluation of malocclusion types in adult patients with nasal septal defects - an observational cross-sectional analysis. J Pharm Bioallied Sci 2024;16:S1147-S1153.
- 23. Zettergren-Wijk L, Forsberg CM, Linder-Aronson S. Changes in dentofacial morphology after adeno-/tonsillectomy in young children with obstructive sleep apnoea—a 5-year follow-up study. Eur J Orthod 2006;28:319-326.
- 24. Grymer LF, Pallisgaard C, Melsen B. The nasal septum in relation to the development of the nasomaxillary complex: A study in identical twins. Laryngoscope 1991;101:863-868.
- 25. Abou Sleiman R, Saadé A. Effect of septal deviation on nasomaxillary shape: A geometric morphometric study. J Anat 2021;239:788-800.
- 26. Serifoglu I, Oz II, Damar M, Buyukuysal MC, Tosun A, Tokgöz Ö. Relationship between the degree and direction of nasal septum deviation and nasal bone morphology. Head Face Med 2017;13:3.
- 27. Abushehab A, Rames JD, Hussein SM, Meire Pazelli A, Sears TA, Wentworth AJ, Morris JM, Sharaf BA. Midface skeletal sexual dimorphism: lessons learned from advanced three-dimensional imaging in the white population. Plast Reconstr Surg 2024;12:e6215
- 28. Uysal T, Sari Z. Posteroanterior cephalometric norms in Turkish adults. Am J Orthod Dentofac Orthop. 2005;127:324-332.
Abstract
Project Number
Not applicable
References
- 1. Mladina R, Čujić E, Šubarić M, Vuković K. Nasal septal deformities in ear, nose, and throat patients: an international study. Am J Otolaryngol 2008;29:75-82.
- 2. Koo SK, Kim JD, Moon JS, Jung SH, Lee SH. The incidence of concha bullosa, unusual anatomic variation and its relationship to nasal septal deviation: A retrospective radiologic study. Auris Nasus Larynx 2017;44:561-570.
- 3. Yildirim I, Okur E. The prevalence of nasal septal deviation in children from Kahramanmaras, Turkey. Int J Pediatr Otorhinolaryngol 2003;67:1203-1206.
- 4. Stallman JS, Lobo JN SP. The Incidence of Concha Bullosa and Its Relationship to Nasal Septal Deviation and Paranasal Sinus Disease. Am J Neuroradiol 2004;25:1613-1618.
- 5. Moss ML, Salentijn L. The primary role of functional matrices in facial growth. Am J Orthod 1969;55:566-577.
- 6. Linder Aronson S. Effects of adenoidectomy on mode of breathing, size of adenoids and nasal airflow. ORL J Otorhinolaryngol Relat Spec 1973;35:283-302.
- 7. Pereira SRA, Bakor SF, Weckx LLM. Adenotonsillectomy in facial growing patients: spontaneous dental effects. Braz J Otorhinolaryngol 2011;77:600-604.
- 8. D’Ascanio L, Lancione C, Pompa G, Rebuffini E, Mansi N, Manzini M. Craniofacial growth in children with nasal septum deviation: A cephalometric comparative study. Int J Pediatr Otorhinolaryngol 2010;74:1180-1183.
- 9. Akbay E, Cokkeser Y, Yilmaz O, Cevik C. The relationship between posterior septum deviation and depth of maxillopalatal arch. Auris Nasus Larynx 2013;40:286-290.
- 10. Fabiana B, Alberto B, Salvatore R, Alessandro N, Paola C. Is there a correlation between nasal septum deviation and maxillary transversal deficiency? A retrospective study on prepubertal subjects. Int J Pediatr Otorhinolaryngol 2016;83:109-112.
- 11. Mladina R, Čujić E, Šubarić M, Vuković K. Nasal septal deformities in ear, nose, and throat patients: an international study. Am J Otolaryngol 2008;29:75-82.
- 12. Kim H-Y. Statistical notes for clinical researchers: Evaluation of measurement error 2: Dahlberg’s error, Bland-Altman method, and Kappa coefficient. Restor Dent Endod 2013;38:182.
- 13. Anderson PJ, Yong R, Surman TL, Rajion ZA, Ranjitkar S. Application of three-dimensional computed tomography in craniofacial clinical practice and research. Aust Dent J 2014;59:174-185.
- 14. Codari M, Zago M, Guidugli GA, Pucciarelli V, Tartaglia GM, Ottaviani F, Righini S, Sforza C. The nasal septum deviation index (NSDI) based on CBCT data. Dentomaxillofacial Radiol 2016;45:20150327.
- 15. Periyasamy V, Bhat S, Sree Ram MN. Classification of naso septal deviation angle and its clinical implications: a ct scan imaging study of palakkad population, india. Indian J Otolaryngol Head Neck Surg 2018;71:2004.
- 16. Kawalski H, Śpiewak P. How septum deformations in newborns occur. Int J Pediatr Otorhinolaryngol 1998;44:23-30.
- 17. Ozturk EMA, Yalcin ED. Examination of the relationship between concha bullosa with nasal septum deviation and maxillary sinus pathologies using cone-beam computed tomography. Cumhur Dent J 2022;25:19-23.
- 18. Ahn JC, Kim JW, Lee CH, Rhee CS. Prevalence and risk factors of chronic rhinosinusitus, allergic rhinitis, and nasal septal deviation: results of the korean national health and nutrition survey 2008-2012. JAMA Otolaryngol Head Neck Surg 2016;142:162-167.
- 19. Janovic N, Janovic A, Milicic B, Djuric M. Relationship between nasal septum morphology and nasal obstruction symptom severity: computed tomography study. Braz J Otorhinolaryngol 2022;88:663-668.
- 20. Bektaş B, Buyuk SK, Benkli YA, Ozkan S. Nazal septum deviasyonlarinin iskeletsel ve dental etkilerinin postero-anterior radyograflarla değerlendirilmesi. Atatürk Üniv Diş Hek Fak Derg 2016;26(1):73-78.
- 21. Fabiana B, Alberto B, Salvatore R, Alessandro N, Paola C. Is there a correlation between nasal septum deviation and maxillary transversal deficiency? A retrospective study on prepubertal subjects. Int J Pediatr Otorhinolaryngol 2016;83:109-112.
- 22. Ganesan P, Golla UR, Balashanmugam B, Munuswamy GL. Evaluation of malocclusion types in adult patients with nasal septal defects - an observational cross-sectional analysis. J Pharm Bioallied Sci 2024;16:S1147-S1153.
- 23. Zettergren-Wijk L, Forsberg CM, Linder-Aronson S. Changes in dentofacial morphology after adeno-/tonsillectomy in young children with obstructive sleep apnoea—a 5-year follow-up study. Eur J Orthod 2006;28:319-326.
- 24. Grymer LF, Pallisgaard C, Melsen B. The nasal septum in relation to the development of the nasomaxillary complex: A study in identical twins. Laryngoscope 1991;101:863-868.
- 25. Abou Sleiman R, Saadé A. Effect of septal deviation on nasomaxillary shape: A geometric morphometric study. J Anat 2021;239:788-800.
- 26. Serifoglu I, Oz II, Damar M, Buyukuysal MC, Tosun A, Tokgöz Ö. Relationship between the degree and direction of nasal septum deviation and nasal bone morphology. Head Face Med 2017;13:3.
- 27. Abushehab A, Rames JD, Hussein SM, Meire Pazelli A, Sears TA, Wentworth AJ, Morris JM, Sharaf BA. Midface skeletal sexual dimorphism: lessons learned from advanced three-dimensional imaging in the white population. Plast Reconstr Surg 2024;12:e6215
- 28. Uysal T, Sari Z. Posteroanterior cephalometric norms in Turkish adults. Am J Orthod Dentofac Orthop. 2005;127:324-332.
Details
| Primary Language | English |
|---|---|
| Subjects | Orthodontics and Dentofacial Orthopaedics |
| Journal Section | RA |
| Authors | |
| Project Number | Not applicable |
| Publication Date | September 30, 2025 |
| Submission Date | March 25, 2025 |
| Acceptance Date | August 29, 2025 |
| Published in Issue | Year 2025 Volume: 28 Issue: 3 |
Cumhuriyet Dental Journal (Cumhuriyet Dent J, CDJ) is the official publication of Cumhuriyet University Faculty of Dentistry. CDJ is an international journal dedicated to the latest advancement of dentistry. The aim of this journal is to provide a platform for scientists and academicians all over the world to promote, share, and discuss various new issues and developments in different areas of dentistry. First issue of the Journal of Cumhuriyet University Faculty of Dentistry was published in 1998. In 2010, journal's name was changed as Cumhuriyet Dental Journal. Journal’s publication language is English.
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