Murat Damar1*, Aykut Erdem Dinc2, Sultan Sevik Elicora1, Sultan Biskin1, Ismail Serifoglu2, Duygu Erdem1 and Ibrahim Ilker Oz2
1Department of Otorhinolaryngology Head and Neck Surgery, Bulent Ecevit University Faculty of Medicine. Zonguldak, Turkey 2Department of Radiology, Bulent Ecevit University Faculty of Medicine. Zonguldak, Turkey
Received: 13 October, 2015; Accepted: 07 November, 2015; Published: 10 November, 2015
Dr. Murat Damar, Bulent Ecevit University Faculty of Medicine, Department of Otolaryngology, Kozlu / Zonguldak, 67600, Turkey, Tel: +90 (372) 2612835; +90 (506) 297 72 83; Fax: +90 (372) 2610264; E-mail:
Damar M, Dinc AE, Elicora SS, Biskin S, Serifoglu I, et al. (2015) Midface Osseous Dimensions are not Affected by Uncorrected Nasal Septal Deviation. Arch Otolaryngol Rhinol 1(2): 048-52. DOI: 10.17352/2455-1759.000009
© 2015 Damar M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Pyriform aperture; Nasal septum; Midface; Maxilla; Facial height
Objective:To investigate the effects of uncorrected nasal septal deviation on the pyriform aperture (PA) dimensions, the upper anterior face height (UAFH), and the anteroposterior length of the maxilla (LM) of adult patients.
Methods: The study included 150 patients (104 males, 46 females; 18-63 years) who had paranasal sinus CT. The study population consisted of 51 patients with anterior nasal septal deviation (NSD) (group I), 72 patients with posterior NSD (group II) and 27 patients with no NSD (group III). By using multiplanar reconstruction (MPR) technique, on coronal plane the width of PA (PAW), the right and left maxilla spinal length (RMSL and LMSL) and the angle of the septal deviation (ASD) and on sagittal plane the height of the PA (PAH), the UAFH and the LM were measured.
Results: There was no difference in PAW, PAH, right and left MSL, UAFH and LM among the groups. Using bivariate correlation, there was no correlation between ASD and PAH, AUFH, LM, RMSL, LMSL, ipsilateral MSL, and contralateral MSL. However, there was weak correlation between ASD and PAW (r = - 0.182, P = 0.044).
Conclusion: The study suggest that nasal septal deviation does not affect PA dimensions, UAFH, and LM.
The adequate width and length of osseous structures in midface is important for nasal physiology and normal facial appearance. For the osseous and cartilage structures during the development process in midface interact with one another, structural changes caused by genetic, or trauma in these structures may affect the nasal physiology and development of the midface.
The nasal septum is a dynamic structure in the nasal cavity midline and consists of cartilage, bone, and fibrous tissue. All of these tissues have different physical and biological properties. These properties make the nasal septum important in the point of the development of midface. The effect of nasal septum on midface growth can be explained by a few theories. According to the nasal septal traction model, the nasal septal cartilage acts as a growth plate, placing tension on the premaxillary suture via septopremaxillary ligament, thus inducing an osteogenic response [1,2]. A second theory suggests that the importance of the nasal septal cartilage as a growth center intrinsic to the facial skeleton is growth center theory, as surgical resection of all or part of the nasal septum in a variety of animal models results in a deficiency in the anteroposterior dimensions of the maxilla and premaxillar .
Morphological abnormalities of the upper jaw can be seen more frequently in subjects suffering from nasal septal deformities . These abnormalities in patients with nasal septal deviation (NSD) are not known to be a cause or a result of nasal septal deviations. There are very few studies investigating the association between NSD and facial development in human being . Most of the studies in literature have focused on the influence of nasal septum that has been operated on or traumatized in early age, leading to growth differences of the surrounding structures [6,7]. So far, the pyriform aperture dimensions have not been studied in patients with NSD. The aim of this study was to investigate the effects of uncorrected NSD on the pyriform aperture dimensions and the upper anterior face height, and the anteroposterior length of the maxilla.
Materials and Methods
Computed tomography (CT) images, demographic and clinical characteristics of the patients, from the archives of Bulent Ecevit University Faculty of Medicine, were obtained and analyzed for this retrospective study.
The exclusion criteria were accepted as follows; age <18 years, acute or chronic rhinosinusitis, previous nasal and/or paranasal surgery, S-shaped septum deviation, sinonasal tumor and congenital craniofacial anomalies.
From January 2013 to May 2015, 150 patients with computed tomography (CT) scans available were identified. The study group included 123 consecutive patients with nasal septal deviation who underwent endonasal and extracorporeal septoplasty, and divided into two groups. Fifty one patients who had more anteriorly placed deviations in front of the inferior turbinate were accepted as the anterior septum deviation (group I), and 72 patients with deviation to right or left without any effect on the internal nasal valve were accepted as posterior deviation (group II). Twenty seven patients constituted the control group without any septum deviations and sinonasal morbidity who were investigated for cephalgia etiology (group III).
CT imaging and measurements
CT examinations were performed by using an Activion 16 CT Scanner (Toshiba Medical Systems, 2008 Japan). The routine paranasal sinus CT protocol was used for all patients with 120 kVp; 100–150 mA; 1.0 mm axial slice thickness; 512 x 512 matrix size; 240 mm field of view. Osirix Imaging Software (Pixmeo, Geneva, Switzerland) on MacPro laptop (Apple) was used for the analysis. The measurements were performed using multiplanar reconstruction (MPR) technique. To resolve the asymmetry associated with positioning, the angle of reformatted image was adjusted until the basal turns of the cochlea were equally viewable in axial and coronal planes.
The width of the pyriform aperture (PAW) was defined as transvers distance between the right and the left frontal process of maxilla where it was the first appearance of inferior turbinate bone on the coronal planes. At the same section, the distance between the right and left frontal process of maxilla to anterior nasal spine was regarded as right maxillospinal length (RMSL) and left maxillospinal length (LMSL), respectively (Figure 1).
- Siegel MI, Mooney MO, Kimes KR, Todhunter J (1991) Developmental correlates of midfacial components in in a normal and cleft lip and palate human fetal sample. Cleft Palate Craniofac J 28: 408-412.
- Wealthall RJ, Herring SW (2006) Endochondral ossification of mouse nasal septum. Anat Rec A Discov Mol Cell Evol Biol 288: 1163-1172.
- Wexler MR, Sarnat BG (1961) Rabbit snout growth. Effect of injury to the septo-vomeral region. Arch Otolaryngol 74: 305-313.
- Mladina R (1987) The role of maxillar morphology in the development of pathological septal deformities. Rhinology 25: 199-205.
- Kim YM, Rha KS Weissman JD, Hwang PH, Most SP (2011) Correlation of asymmetric facial growth with deviated nasal septum. Laryngoscope 121: 1144-1148.
- El-Hakim H, Crysdale WS, Abdollel M, Farkas LG (2001) A study of anthropometric measures before and after external septoplasty in children: a preliminary study. Arch Otolaryngol Head Neck Surg 127: 1362–1366.
- Brain DJ, Rock WP (1983) The influence of nasal trauma during childhood on growth of the facial skeleton. J Laryngol Otol 97: 917–923.
- Rhys Evans PH and Brain DJ (1981) Effects of nasal surgery on the growth of the rabbit snout. Rhinology 19: 101-105.
- Van Loosen J, Van Zanten GA, Howard CV, Verwoerd-Verhoef HL, Van Velzen D, et al. (1996) Growth characteristics of the human nasal septum. Rhinology 34: 78-82.
- Wong KK, Filatov S, Kibblewhite DJ (2010) Septoplasty retards midfacial growth in a rabbit model. Laryngoscope 120: 450-453.
- Tasca I, Compadretti GC (2011) Nasal growth after pediatric septoplasty at long-term follow-up. Am J Rhinol Allergy 25: 7-12.
- Grymer LF, Melsen B (1989) The morphology of the nasal septum in identical twins. Laryngoscope 99: 642-646.
- Pirsig W (1992) Growth of the deviated septum and its influence on midfacial development. Facial Plast Surg 8: 224–232.
- D'Ascanio L, Lancione C, Pompa G, Rebuffini E, Mansi N, et al. (2010) Craniofacial growth in children with nasal septum deviation: a cephalometric comparative study. Int J Pediatr Otorhinolaryngol 74: 1180-1183.
- Lopez MC, Galdames ICS, Matamala DAZ, Smith RL (2009) Sexual dimorphism determination by piriform aperture morphometric analysis in Brazilian human skulls. Int J Morphol 27: 327–331.
- Yuzbasioglu N, Yilmaz MT, Cicekcibasi AE, Seker M, Sakarya ME (2014) The evaluation of morphometry of nasal bone and pyriform aperture using multidetector computed tomography. J craniofac Surg 25: 2214-2219.
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