Changes in nasal septum morphology after rapid maxillary expansion: a Cone-Beam Computed Tomography study in pre-pubertal patient.

Giovanni Bruno,Alberto De Stefani,Antonio Gracco,Celeste Benetazzo,Francesco Cavallin

doi:10.1590/2177-6709.25.5.051-056.oar

Giovanni Bruno, Alberto De Stefani + Show 3 more

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https://doi.org/10.1590/2177-6709.25.5.051-056.oar

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Abstract

ABSTRACTIntroduction: Nasal septum deviation (NSD) is the most common structural cause of nasal obstruction, affecting around 65-80% of the adult population. Rapid maxillary expansion (RME) is currently used for treatment of maxillary transverse deficiency, but can also influence nasal cavity geometry. Objective: The present study aimed at evaluating the changes in NSD by using Cone-Beam Computed Tomography (CBCT) scans in pre-pubertal patients treated with RME. Methods: This retrospective exploratory study evaluated 20 pre-pubertal patients (mean age 10 ± 2 years) who were treated for transverse maxillary constriction with RME and presented mild/moderate NSD as an incidental finding. The outcome measures were NSD tortuosity and area. These measures were obtained from transverse and coronal views of records taken before and after RME treatment. Intra-rater reliability was also assessed with intraclass correlation coefficient.Results: NSD was mild in thirteen patients (65%) and moderate in seven (35%). NSD tortuosity index did not significantly change over time (mean difference 0.002 mm/year, 95% CI; p = 0.58). NSD area did not significantly change over time (mean difference 2.103 mm2/year, 95% CI; p = 0.38). Intraclass correlation coefficient was 0.73 (95% CI) for NSD tortuosity and 0.84 (95% CI) for NSD area. Conclusions: NSD tortuosity and area suggested potential changes in NSD with small clinical relevance in pre-pubertal patients who were treated with RME. Additional studies using CBCT scans in larger samples are required to clarify the role of RME in NSD treatment.

Highlights

Nasal septum deviation (NSD) is the most common structural cause of nasal obstruction, affecting around 65-80% of the adult population
The study included 20 pre-pubertal individuals: NSD was mild in 13 patients (65%) and moderate in 7 patients (35%)
intraclass correlation coefficient (ICC) was 0.73 for NSD tortuosity and 0.84 for NSD area

Summary

Introduction

Nasal septum deviation (NSD) is the most common structural cause of nasal obstruction, affecting around 65-80% of the adult population. Nasal septum is an osteo-cartilaginous structure forming medial portion of nasal cavity, composed of septal nasal cartilage and perpendicular plate of the ethmoid bone and vomer bone It is an important functional and esthetic structure for proper nasal respiration because it concurs to regulate airflow through the nose.[1] A straight nasal septum ensures a laminar airflow allowing the inspired air to be warmed, humidified and cleaned, in order to optimize the alveolar gas exchanges.[1,2] Inversely, a nasal septum deviation (NSD) concurs to nasal obstruction and impaired nasal respiration.[2] NSD is defined as a deflection from the midline, which can be caused by congenital deformation, traumatic/iatrogenic injury or important nasal infection.[3] NSD is the most common structural cause of nasal obstruction,[1] affecting around 65-80% of the adult population.[4,5] it is often physiological, NSD may require septoplasty surgical operation when it causes a severe grade of obstruction (≥ 16°).[6,7,8] This situation can negatively affect the midfacial development in growing patients.[9] NSD is associated with many skeletal and dental problems, such as Class II malocclusion, increased overjet, retrognathic maxilla and mandible, increased anterior facial height, maxillary transverse deficiency associated with crossbite, high arched palate, low tongue posture and incompetent lips.[1,2,10]

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