Facial Skeletal Dimensions in Patients with Nasal Septal Deviation

Abstract

The anatomy and the concomitant function of the face seem to be reciprocal issues. Previous studies have shown that stenosis in the posterior part of the nose, hampering nasal air flow, is associated with a retrognathic face and a posterior rotation of the lower jaw, i.e. components of the adenoid syndrome. The present study examines facial cephalometric morphology in adults with a deviated nasal septal cartilage, i.e. an anteriorly positioned nasal stenosis. Compared to a group of unafflicted individuals, also with regard to rhinomanometric resistance, a significantly smaller posterior facial height, smaller height of the anterior nasal aperture, a posterior rotation of the lower jaw and a shorter nasal floor and ceiling were found. This may mean that growth of the nasal septal cartilage and growth of the surrounding skeletal areas are out of step. A relatively undersized skeletal frame, in the sagittal plane, may have led to the buckled non-fitting septal cartilage, with increased air flow resistance as a secondary effect. If this interpretation is correct, an early cautious surgical correction of the septal deviation, also balancing this growth incongruence, might be worth serious consideration.

Facial Asymmetry and Nasal Septal Deviation in Acquired Nasolacrimal Duct Obstruction

“…Grymer et al (1991) examined 42 identical twins and found some influence of the nasal septum and total nasal resistance on the development of the nasomaxillary complex. Freng et al (1988) compared the facial growth in deviated and non-deviated septum patients and revealed significant growth problems in surrounding skeletal areas, such as smaller posterior facial height, which causes cartilage buckling, leading to resistance to normal nasal airflow. It seems that the cause of a congenital crooked nose may be part of a larger genetic problem.…”

Nasal septal deviation in a mediaeval population

“…reduced facial prognathism in the former but without addressing causality. Freng et al (1988) found reduced nasal height in NSD, and interpret this as indicating that an undersized bony framework was responsible for the buckling of the growing septum. D' Ascanio et al (2010) report increased facial height in NSD, and ascribe it to the effects of mouth-breathing.…”

“…It might be suggested that traumatic damage to the nasal septum, causing its deviation, may have led to anomalies in development of surrounding bony structures resulting in reduced facial height, especially as experimental evidence largely appears to support the notion of a direct relationship between nasal septal and anterior midfacial growth (discussion in Holton et al, 2011b). This is the implication of the interpretation made by Freng et al (1988) when they observed an association between NSD and reduced nasal height in modern subjects. Although trauma that did not result in fracture would not be detectable, if trauma to the nasal region was a frequent occurrence in the Wharram Percy population, then one would expect that, at least on occasion, it would have resulted in fracture.…”

“…This is thought to arise due to mouth-breathing disrupting normal muscular pressures from the tongue, cheeks, and lips on the dental arches and adjacent facial skeleton (Arun et al, 2003). Freng et al (1988), found shorter palate length in NSD cases with nasal obstruction than in controls, and ascribed this to altered respiratory pattern with increased mouth-breathing. Freng et al (1988), found shorter palate length in NSD cases with nasal obstruction than in controls, and ascribed this to altered respiratory pattern with increased mouth-breathing.…”

“…There is evidence that those showing NSD may differ in some aspects of cranial morphology from those that do not (or from those who show it to a lesser degree) (Brain and Rock, 1983;Freng et al, 1988;D'Ascanio et al, 2010;Holton et al, 2011a). Direction of causality in these associations may be difficult to establish.…”