Orientation of the premaxilla in the origin of septal deviation

  • Ari J. Hyman
  • Judd H. Fastenberg
  • Howard D. StupakEmail author



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.


Septal deviation Rhinoplasty Tension nose deformity Embryology 


Compliance with ethical standards

Conflict of interest

We have no potential conflicts of interest.

Ethical standards

This study was IRB-approved by Jacobi Medical Center/Albert Einstein College of Medicine.

Human/animal rights

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


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Ari J. Hyman
    • 1
  • Judd H. Fastenberg
    • 1
  • Howard D. Stupak
    • 1
    Email author
  1. 1.Department of Otorhinolaryngology-Head and Neck Surgery, Jacobi Medical CenterAlbert Einstein College of MedicineBronxUSA

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