Nasal Septum Deviation and Inferior Nasal Concha Bone Hypertrophy in Class III Facial Deformity

Abstract

The aim of this research was to analyze the morphology of the nasal septum and inferior nasal concha bone in class III facial deformities prior to orthodontic treatment in orthognathic surgery candidates. 40 subjects were included in this research. The inclusion criteria were an Angle class III, negative overjet and SNA angle less than 80º. Patients with facial asymmetry, facial trauma or who had undergone maxillofacial or ENT procedures were excluded. CBCT images were obtained for all the patients and the nasal septum deviation, morphology of inferior nasal concha bone and ostium of the maxillary sinus were analyzed and related to the complexity of the facial deformity expressed by the ANB angle and dental relations. The measurement was standardized by ICC and the data was analyzed using a chi square test and Spearman's coefficient with a p value < 0.005 for statistical significance. Nasal septal deviation was observed in 77.5 %. The deviation angle was 13.28º (±4.68º) and the distance from the midline to the most deviated septum was 5.56 mm (±1.8 mm) with no statistical relation to the complexity of the facial deformity. The deviated nasal septum showed inferior nasal concha bone hypertrophy on the concave side of the nasal septum deviation (p=0.049). The open or closed condition of the maxillary sinus ostium was not related to any conditions in the septum or complexity of the facial deformity. Inferior nasal concha bone hypertrophy could be related to nasal septal deviation. The nasal condition in a class III facial deformity could not differ from the general population; careful in orthognathic surgery as to be assume in the Le Fort I Osteotomy and nasal approach related to nasal septum deviation and inferior nasal concha bone.

Korelasi Hipertrofi Konka Inferior Terhadap Derajat Deviasi Septum Nasi Menggunakan Modalitas Ct Scan Pada Pasien Deviasi Septum Nasi

“…HTI pada sisi cekung dari deviasi septum dapat bersifat reaktif dan mengkompensasi area di lubang hidung, sehingga hipertrofi ini dapat disebabkan oleh deviasi septum, yang merupakan penyebab penting perubahan pernapasan hidung ke mulut. 13 Namun hasil menunjukkan tidak terdapat hubungan antara hipertrofi konka inferior terhadap derajat deviasi septum nasi, baik berdasarkan penilaian offset lateral, lebar konka inferior, lebar tulang konka inferior maupun lebar mukosa media. Hal ini tidak sejalan dengan penelitian Villa J, dkk, yang membuktikan bahwa deviasi septum nasi menunjukkan hipertrofi tulang konka nasalis inferior pada sisi cekung deviasi septum nasi (p=0,049).…”

“…Hal ini tidak sejalan dengan penelitian Villa J, dkk, yang membuktikan bahwa deviasi septum nasi menunjukkan hipertrofi tulang konka nasalis inferior pada sisi cekung deviasi septum nasi (p=0,049). 13 Perbedaan hasil ini, disebabkan karena tidak adanya pedoman acuan dalam menilai hipertrofi konka inferior menggunakan CT. Banyak penelitian mengenai hubungan antara hipertrofi konka inferior dengan sudut deviasi septum, namun menggunakan cara pengukuran yang berbeda-beda.…”

Morfología Ósea Facial en Cirugía Ortognática. ¿Existe Tendencia Hacia el Avance Facial?

“…La maxila es el hueso que forma el tercio medio facial. Es un hueso que sustenta el proceso alveolar que soporta los dientes, forma la pirámide nasal, el piso y contorno orbitario y se relaciona con el hueso cigomático para entregar la forma lateral del rostro (Villa et al, 2020;Ravelo et al, 2021a). La mandíbula, por otra parte, desarrolla todo el tercio inferior del rostro, de forma que la posición de la lengua, labios, área submandibular, vía aérea y contorno facial inferior son relacionados con la posición de la mandíbula (Ravelo et al, 2020a;Ravelo et al, 2021b).…”