The influence of orthopedic rapid maxillary expansion on the deviation of the nasal septum

Nasal septal deviation (NSD) is one of the most common abnormalities impacting the maxillofacial development of children. Herein, we investigated the impact of orthopedic rapid maxillary expansion (RME) on the nasomaxillary complex and NSD in pediatric patients. The study sample consisted of a total of 40 patients divided into two groups. The experimental group included 26 patients (13 females and 13 males) with skeletal maxillary transversal constriction and NSD greater than 1 mm, while the control group comprised 14 patients (6 females and 8 males) with skeletal maxillary transversal constriction but no NSD. All the patients were treated for approximately 15 days with the tooth-tissue born RME device. The activation procedure was to turn the transversal Hyrax screw a quarter turn, twice a day. After that, the device was left in place for a period of five months to facilitate passive retention. Radiographic analysis was performed on posteroanterior (PA) cephalometric radiographs taken at pre-expansion (T1) and post-expansion (T2). The data were evaluated using the Mann-Whitney U and Wilcoxon Sign tests. The experimental group showed a statistically significant decrease (p < 0.05) in the distance from the axis of symmetry to middle of nasal septum (SNM-mid) and to inferior part of the nasal septum (SNI-mid) measurements, indicating a reduction in NSD. Additionally, both experimental and control groups showed a statistically significant increase (p < 0.05) in maxillofacial measurements, including the distance between the nose length (X-SNM and SNM-SNAC), width of the nasal cavity (Pir L-R), basal maxillary width (Mx L-R), vestibular cuspid of upper first molars (CVM + L-R) and lower first molars (CVM-L-R). Based on the study findings, RME was considered effective in achieving craniofacial improvement in pediatric patients with NSD, which positively impacted their healthy growth and development. The improvement in the nasomaxillary complex was similar between genders.

Orthodontics; Maxillary expansion; Nasal septum; Gender

[1] Aziz T, Biron VL, Ansari K, Flores-Mir C. Measurement tools for the diagnosis of nasal septal deviation: a systematic review. Journal of Otolaryngology—Head & Neck Surgery. 2014; 43: 11.

[2] Aziz T, Ansari K, Lagravere MO, Major MP, Flores-Mir C. Effect of non-surgical maxillary expansion on the nasal septum deviation: a systematic review. Progress in Orthodontics. 2015; 16: 15.

[3] Farronato G, Giannini L, Galbiati G, Maspero C. RME: influences on the nasal septum. Minerva Stomatologica. 2012; 61: 125–134.

[4] Grippaudo C, Quinzi V, Manai A, Paolantonio EG, Valente F, La Torre G, et al. Orthodontic treatment need and timing: assessment of evolutive malocclusion conditions and associated risk factors. European Journal of Paediatric Dentistry. 2020; 21: 203–208.

[5] Biagi R, Craparo A, Trovato F, Butti AC, Salvato A. Diagnosis of dental and mandibular asymmetries in children according to Levandoski Panoramic Analysis. European Journal of Paediatric Dentistry. 2012; 13: 297–300.

[6] Sanders DA, Chandhoke TK, Uribe FA, Rigali PH, Nanda R. Quantification of skeletal asymmetries in normal adolescents: cone-beam computed tomography analysis. Progress in Orthodontics. 2014; 15: 26.

[7] Qamar Z, Alghamdi AMS, Haydarah NKB, Balateef AA, Alamoudi AA, Abumismar MA, et al. Impact of temporomandibular disorders on oral health-related quality of life: A systematic review and meta-analysis. Journal of Oral Rehabilitation. 2023; 00: 1–9.

[8] Balikci HH, Gurdal MM, Celebi S, Ozbay I, Karakas M. Relationships among concha bullosa, nasal septal deviation, and sinusitis: retrospective analysis of 296 cases. Ear, Nose & Throat Journal. 2016; 95: 487–491.

[9] Minervini G, Franco R, Marrapodi MM, Fiorillo L, Cervino G, Cicciù M. Prevalence of temporomandibular disorders in children and adolescents evaluated with Diagnostic Criteria for Temporomandibular Disorders: A systematic review with meta-analysis. Journal of Oral Rehabilitation. 2023; 50: 522–530.

[10] Fagundes NCF, Minervini G, Furio Alonso B, Nucci L, Grassia V, d’Apuzzo F, et al. Patient-reported outcomes while managing obstructive sleep apnea with oral appliances: a scoping review. Journal of Evidence-Based Dental Practice. 2023; 23: 101786.

[11] Altug Atac AT, Karasu HA, Aytac D. Surgically assisted rapid maxillary expansion compared with orthopedic rapid maxillary expansion. The Angle Orthodontist. 2006; 76: 353–359.

[12] Minervini G, Franco R, Marrapodi MM, Fiorillo L, Gervino G, Cicciù M. Prevalence of temporomandibular disorders (TMD) in pregnancy: a systematic review with meta-analysis. Journal of Oral Rehabilitation. 2023; 50: 627–634.

[13] Warren DW, Hershey G, Turvey TA, Hinton VA, Hairfield WM. The nasal airway following maxillary expansion. American Journal of Orthodontics and Dentofacial Orthopedics. 1987; 91: 111–116.

[14] Gökçe G, Akan B, Veli İ. A postero-anterior cephalometric evaluation of different rapid maxillary expansion appliances. Journal of the World Federation of Orthodontists. 2021; 10: 112–118.

[15] Hartman C, Holton N, Miller S, Yokley T, Marshall S, Srinivasan S, et al. Nasal septal deviation and facial skeletal asymmetries. The Anatomical Record. 2016; 299: 295–306.

[16] Lee HJ, Park JH, Seo HY, Choi SK, Chang NY, Kang KH, et al. A CBCT evaluation of nasal septal deviation and related nasofacial structures after maxillary skeletal expansion. Applied Sciences. 2022; 12: 9949.

[17] Seidita F, de Azambuja Carvalho PH, Dos Sántos JC, Dell’Aversana Orabona G, Califano L, Gabrielli MFR, et al. Nasal septal deviation after surgically assisted rapid maxillary expansion. Journal of Maxillofacial and Oral Surgery. 2022; 21: 765–771.

[18] Bruno G, Stefani A De, Benetazzo C, Cavallin F, Gracco A. Changes in nasal septum morphology after rapid maxillary expansion: a cone-beam computed tomography study in pre-pubertal patient. Dental Press Journal of Orthodontics. 2020; 25: 51–56.

[19] Ballanti F, Baldini A, Ranieri S, Nota A, Cozza P. Is there a correlation between nasal septum deviation and maxillary transversal deficiency? A retrospective study on prepubertal subjects. International Journal of Pediatric Otorhinolaryngology. 2016; 83: 109–112.

[20] Fabiani G, Galván Galván J, Raucci G, Elyasi M, Pachêco-Pereira C, Flores-Mir C, et al. Pharyngeal airway changes in pre-pubertal children with class II malocclusion after Fränkel-2 treatment. European Archives of Paediatric Dentistry. 2017; 18: 291–295.

[21] Fernandes P, Pinto J, Ustrell-Torrent J. Relationship between oro and nasopharynx permeability and the direction of facial growth. European Archives of Paediatric Dentistry. 2017; 18: 37–40.

[22] Smith KD, Edwards PC, Saini TS, Norton NS. The prevalence of concha bullosa and nasal septal deviation and their relationship to maxillary sinusitis by volumetric tomography. International Journal of Dentistry. 2010; 2010: 1–5.

[23] Sazgar AA, Massah J, Sadeghi M, Bagheri A, Rasool E. The incidence of concha bullosa and the correlation with nasal septal deviation. B-ENT. 2008; 4: 87–91.

[24] Gokce G, Veli I, Yuce YK, Isler Y. Efficiency evaluation of rapid maxillary expansion treatment on nasal septal deviation using tortuosity ratio from cone-beam computer tomography images. Computer Methods and Programs in Biomedicine. 2020; 188: 105260.

[25] Gray LP. Results of 310 cases of rapid maxillary expansion selected for medical reasons. The Journal of Laryngology & Otology. 1975; 89: 601–614.

[26] Minervini G, Franco R, Marrapodi MM, Mehta V, Fiorillo L, Badnjević A, et al. The association between COVID-19 related anxiety, stress, depression, temporomandibular disorders, and headaches from childhood to adulthood: a systematic review. Brain Sciences. 2023; 13: 481.

[27] Bicakci AA, Agar U, Sökücü O, Babacan H, Doruk C. Nasal airway changes due to rapid maxillary expansion timing. The Angle Orthodontist. 2005; 75: 1–6.

[28] Altug-Atac AT, Atac MS, Kurt G, Karasud HA. Changes in nasal structures following orthopaedic and surgically assisted rapid maxillary expansion. International Journal of Oral and Maxillofacial Surgery. 2010; 39: 129–135.

[29] Büyükgöze Dindar M, Tekbaş Atay M. The effect of toothbrush abrasion on wear and surface roughness of direct and indirect composite laminate veneer restorations. Surface Topography. 2020; 8: 035007.

[30] Dindar M, Açıkgöz-Alparslan E, Tekbaş-Atay M. Radiographic evaluation of marginal bone height and density around overhanging dental restorations. The International Journal of Periodontics & Restorative Dentistry. 2022; 42: 401–408.

[31] Marcu M, Hedesiu M, Salmon B, Pauwels R, Stratis A, Oenning ACC, et al. Estimation of the radiation dose for pediatric CBCT indications: a prospective study on ProMax3D. International Journal of Paediatric Dentistry. 2018; 28: 300–309.

[32] Eichenberger M, Baumgartner S. The impact of rapid palatal expansion on children’s general health: a literature review. European Archives of Paediatric Dentistry. 2014; 15: 67–71.

[33] Shams N, Razavi M, Zabihzadeh M, Shokuhifar M, Rakhshan V. Associations between the severity of nasal septal deviation and nasopharynx volume in different ages and sexes: a cone-beam computed tomography study. Maxillofacial Plastic and Reconstructive Surgery. 2022; 44: 13.

[34] Di Francesco R, Monteiro R, Paulo MLDM, Buranello F, Imamura R. Craniofacial morphology and sleep apnea in children with obstructed upper airways: differences between genders. Sleep Medicine. 2012; 13: 616–620.

[35] Serifoglu I, Oz İİ, Damar M, Buyukuysal MC, Tosun A, Tokgöz Ö. Relationship between the degree and direction of nasal septum deviation and nasal bone morphology. Head & Face Medicine. 2017; 13: 3.