Nasal septum changes in adolescent patients treated with rapid maxillary expansion

Abstract

Objective: To analyze cone-beam computed tomography (CBCT) scans to measure changes in nasal septal deviation (NSD) after rapid maxillary expansion (RME) treatment in adolescent patients. Methods: This retrospective study involved 33 patients presenting with moderate to severe nasal septum deviation as an incidental finding. Out of these 33 patients, 26 were treated for transverse maxillary constriction with RME and seven, who did not undergo RME treatment, were included in the study as control group. CBCT scans were taken before appliance insertion and after appliance removal. These images were analyzed to measure changes in nasal septum deviation (NSD). Analysis of variance for repeated measures (ANOVA) was used. Results: No significant changes were identified in NSD regardless of the application or not of RME treatment and irrespective of the baseline deviation degree. Conclusion: This study did not provide strong evidence to suggest that RME treatment has any effect on NSD in adolescent patients; however, the results should be interpreted with caution, due to the small sample size and large variation amongst individual patient characteristics.

Changes in nasal septum morphology after rapid maxillary expansion: a Cone-Beam Computed Tomography study in pre-pubertal patient

“…CBCT scans are among the suggested diagnostic tools for NSD because it provides an accurate evaluation of anatomical measurements and allows a comprehensive assessment of deviation-related respiratory problems. 2 The present data showed good reliability of CBCT scans in identification of anatomical landmarks, in agreement with Aziz et al 17 RME is a beneficial procedure in the resolution of maxillary constriction but also in the treatment of nasal respiratory problems. 12,26 The opening of the midpalatal suture allows significant widening of maxillary bone and increasing of intranasal cavity.…”

“…The present findings were in agreement with a previous study evaluating NSD in adolescents by using CBCT scans. 17 Aziz et al 17 did not report any significant effect of RME in adolescents who were treated for mild to severe NSD. Other two studies investigated RME in NSD by using posteroanterior radiographs.…”

“…The main weakness of these studies is the measurement using posteroanterior radiographs. Aziz et al 17 evaluated NSD using Cone-Beam Computed Tomography (CBCT) scans and did not find any significant differences in NSD after treatment with RME in adolescents. However, using RME should be preferred before the pubertal peak of growth (CS1-CS3 [18][19][20] ) in order to achieve orthopedic rather than dental effects.…”

Three-dimensional nasal septum and maxillary changes following rapid maxillary expansion in patients with cleft lip and palate:

“…22 The literature is controversial regarding the effects of RME on NS deviation, which occurs more frequently in patients with clefts than in patients without clefts. 23 It was reported that NS deviation tended to straighten, 10,24 remained unaltered, 11,12 interfered with the expansion of the maxilla, or moved along with it during expansion in patients without clefts. 25 In addition, the osteotomy of the NS is generally defended to prevent deviation of the septum during the separation of the maxillary bones, 25 although no significant differences were found between cases with and without osteotomy.…”

“…10 Others have reported that there was no alteration in the NS after RME. 11,12 In addition, although the effects of RME on the upper airways 13 and on the UCLP 8,14 are well documented, there is a lack of studies in the literature that analyzed its effects on the nasal septum in UCLP patients, especially using cone-beam computed tomography (CBCT).…”