The relationship between posterior septum deviation and depth of maxillopalatal arch

Akbay, Ercan; Çokkeser, Yaşar; Yılmaz, Ömer; Çevik, Cengiz

doi:10.1016/j.anl.2012.07.016

Cited by 25 publications

(25 citation statements)

References 10 publications

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“…Rather than relying on qualitative or two-dimensional quantitative approaches to measuring septal deviation used elsewhere (Gray, 1978;Gray et al 1982;Takahashi, 1987;Subari c & Mladina, 2002;Yildirim & Okur, 2003;Hafezi et al 2010;Kim et al 2011;Akbay et al 2013), we utilized a quantitative three-dimensional approach that takes into account the morphology of the entire nasal septum (Holton et al 2012;Foster & Holton, 2016;Hartman et al 2016). This allows for a more accurate characterization of nasal septal morphology, including the magnitude of septal deviation, and thus allows for a more detailed assessment of the interaction between the nasal septum and surrounding nasofacial skeleton.…”

Section: Methodsmentioning

confidence: 99%

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

2017

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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.

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Section: Methodsmentioning

confidence: 99%

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

2017

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“…In contrast to previous studies that have relied on qualitative (Gray, ; Akbay et al, ) or simpler two‐dimensional approaches (Hafezi et al, ; Kim et al, ) for measuring nasal septal deviation, we utilized a 3D quantitative method that accounts for the overall morphology of the nasal septum. This results in a more accurate assessment of the magnitude of nasal septal deviation across the entire septum and gives us finer resolution for assessing the relationship between septal deviation and facial asymmetry.…”

Section: Methodsmentioning

confidence: 99%

“…The results from previous studies suggest that there is a relationship between nasal septal deviation and facial asymmetries; however, these studies have been conducted using either two‐dimensional photographs (Hafezi et al, ; Kim et al, ) or dental casts (Gray, ; Pirsig, ). Moreover, nasal septal deviation is often treated as a categorical variable (Gray, ; Akbay et al, ) or is measured only in a single region of the nasal septum (Kim et al, ). As such, there is limited information regarding the relationship between the overall magnitude of septal deviation and three‐dimensional (3D) patterns of facial skeletal asymmetry.…”

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confidence: 99%

Nasal Septal Deviation and Facial Skeletal Asymmetries

Hartman

Holton

Miller

et al. 2016

The Anatomical Record

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During ontogeny, the nasal septum exerts a morphogenetic influence on the surrounding facial skeleton. While the influence of the septum is well established in long snouted animal models, its role in human facial growth is less clear. If the septum is a facial growth center in humans, we would predict that deviated septal growth would be associated with facial skeletal asymmetries. Using computed tomographic (CT) scans of n 5 55 adult subjects, the purpose of this study was to test whether there is a correlation between septal deviation and facial asymmetries using three-dimensional (3D) geometric morphometric techniques. We calculated deviation as a percentage of septal volume relative to the volume of a modeled non-deviated septum. We then recorded skeletal landmarks representing the nasal, palatal, and lateral facial regions. Landmark data were superimposed using Procrustes analysis. First, we examined the correlation between nasal septal deviation and the overall magnitude of asymmetry. Next, we assessed whether there was a relationship between nasal septal deviation and more localized aspects of asymmetry using multivariate regression analysis. Our results indicate that while there was no correlation between septal deviation and the overall magnitude of asymmetry, septal deviation was associated with asymmetry primarily in the nasal floor and the palatal region. Septal deviation was unassociated with asymmetries in the lateral facial skeleton. Though we did not test the causal relationship between nasal septal deviation and facial asymmetry, our results suggest that the nasal septum may have an influence on patterns of adult facial form. Anat Rec, 299:295-306, 2016. V C 2015 Wiley Periodicals, Inc. Key words: ontogeny; geometric morphometrics; facial skeletonCraniofacial and occlusal asymmetries are commonly observed in populations and can result from a number of causative factors. These include the early loss of primary teeth, loss of permanent teeth, genetic or congenital malformations (e.g., hemifacial microsomia, unilateral clefts, etc.), environmental factors (e.g., habits and trauma), and functional deviations (Bishara et al., 1994;Burstone, 1998

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“…There (Smith et al 1988;Park 1993). Increased nasal resistance also results in compensatory oral breathing, which leads to an unstable airway with increased total resistance (Phillips 2006;Akbay et al 2013). Finally, decreased nasal airflow blunts the activation of the nasal-ventilatory reflex important in the maintenance of adequate muscle tone, breathing frequency, and minute lung ventilation (Mcnicholas;Douglas et al 1983).…”

Section: Discussionmentioning

confidence: 99%

“…Continuous oral breathing often leads to a transverse maxillary deficiency that deepens the palatal arch. The high arched palate may compress the septum in a cranio-caudal orientation, thus resulting in a displaced septum (Akbay et al 2013). Most of the posterior septal deviation that cannot be visualized using anterior rhinoscopy alone are not from traumatic insult, but from pressure exerted by a high arched palate during active craniofacial skeletal development.…”

Section: Discussionmentioning

confidence: 99%

High incidence of posterior nasal cavity obstruction in obstructive sleep apnea patients

Torre

Capasso

Zaghi

et al. 2017

Sleep Science Practice

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Background: Nasal obstruction is a common problem in patients with obstructive sleep apnea (OSA). Systematic evaluation of nasal obstruction remains challenging due to the high number of variables and factors that contribute to nasal obstruction. Nasal examination by means of anterior rhinoscopy is limited to the evaluation of anterior septal deviation, internal nasal valve angle, and inferior turbinate size, but obstruction due to posterior septal deviation and nasal polyposis may go undiagnosed. The primary objective of this study was to determine the incidence of posterior nasal obstruction in OSA patients. Specifically, we were interested in other causes of posterior nasal obstruction that were difficult to assess by anterior rhinoscopy examination alone, and that required nasal endoscopy for identification. Methods: This is a retrospective case series study. Flexible fiberoptic examination of the nasal cavity was performed on 274 consecutive OSA patients evaluated at the Stanford Sleep Surgery Clinic. Examination video files were recorded and later reviewed and scored by a single investigator blinded to the patients' subjective nasal complaints. Anatomic features that contribute to posterior nasal obstruction were noted. Results: Posterior septal deviation was the most common incidental finding in OSA patients with posterior nasal obstruction. Other causes included nasal polyposis, nasal mucosal inflammation, and purulent mucosal discharge. In total, there were 73/274 (26.6%) patients for whom nasal endoscopy provided findings that directed management. Conclusion: Nasal endoscopy provides additional diagnostic information in a significant number of OSA patients who complain of nasal obstruction. Our findings suggest the use of nasal endoscopy for OSA patients who complain of nasal obstruction or CPAP intolerance, despite unremarkable anterior rhinoscopy examination.

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The relationship between posterior septum deviation and depth of maxillopalatal arch

Cited by 25 publications

References 10 publications

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

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

Nasal Septal Deviation and Facial Skeletal Asymmetries

High incidence of posterior nasal cavity obstruction in obstructive sleep apnea patients

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