Orientation of the premaxilla in the origin of septal deviation
- 11 Downloads
While most people believe the nasal septum to have intrinsic deviation and overgrowth in patients seeking rhinoplasty, an alternative concept is that a mal-oriented premaxilla causes extrinsic septal buckling and external extrusion of the septal cartilage. In this sense, the premaxillary bone plays a significant role in the pathogenesis of septal deviation. This study was performed to determine if non-traumatically acquired septal/nasal functional and aesthetic pathology or septal deviation may be related to the orientation of the premaxilla relative to the skullbase.
A retrospective, single-center study of patients in the general population who underwent maxillofacial CT scans and presented for the evaluation of nasal obstruction. CT scans were used to measure features of both pathologic and non-pathologic nasal septums.
A total of 68 subjects were evaluated. When comparing patients with a premaxillary-skullbase angle of greater than 81° (the mean of the study group) to those of less than 81°, and a more obtuse nasolabial angle was observed (p = 0.0269). When comparing the extremes of premaxillary rotation, specifically, greater than 87° (mean 91.7°, SD 5.1) and less than 77° (mean 70.7°, SD 3.6), the differences were more pronounced with regard to caudal septal excess (p = 0.0451) and septal deviation in the axial plane (p = 0.0150).
Septal developmental changes may involve an overly rotated or more vertically oriented premaxillary bone relative to the skull base. An understanding of the cause of septal deformity may provide insight into the design of improved treatments.
KeywordsSeptal deviation Rhinoplasty Tension nose deformity Embryology
Compliance with ethical standards
Conflict of interest
We have no potential conflicts of interest.
This study was IRB-approved by Jacobi Medical Center/Albert Einstein College of Medicine.
Human subjects were involved in this study; however, all data were accumulated and analyzed in a retrospective nature, and therefore, informed consent was not necessary
- 2.Takahashi R (1988) The evolution of the nasal septum and the formation of septal deformity. Rhinol Suppl 6:1–23Google Scholar
- 4.Weinstock MS, Stupak HD (2018) Bony/cartilaginous mismatch: a radiologic investigation into the cause of tension nose deformity. Plast Reconstr Surg 141(2):312–321Google Scholar
- 6.Mladina R (1987) The role of maxillar morphology in the development of pathological septal deformities. Rhinology 25(3):199–205Google Scholar
- 7.Mladina R, Krajina Z (1990) The influence of palato-cranial base (basomaxillary) angle on the length of the caudal process of the nasal septum in man. Rhinology 28(3):185–189Google Scholar