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Article

A CBCT Evaluation of Nasal Septal Deviation and Related Nasofacial Structures after Maxillary Skeletal Expansion

by
Hye-Jeong Lee
1,†,
Jae Hyun Park
2,3,†,
Hye Young Seo
4,
Sung-Kwon Choi
1,5,
Na-Young Chang
1,5,
Kyung-Hwa Kang
1,5 and
Jong-Moon Chae
1,2,5,*
1
Department of Orthodontics, School of Dentistry, University of Wonkwang, Iksan 54538, Korea
2
Postgraduate Orthodontic Program, Arizona School of Dentistry & Oral Health, A.T. Still University, Mesa, AZ 85206, USA
3
International Scholar, Graduate School of Dentistry, Kyung Hee University, Seoul 02447, Korea
4
School of Big Data and Financial Statistics, College of Natural Sciences, University of Wonkwang, Iksan 54538, Korea
5
Wonkwang Dental Research Institute, University of Wonkwang, Iksan 54538, Korea
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to the work.
Appl. Sci. 2022, 12(19), 9949; https://doi.org/10.3390/app12199949
Submission received: 9 September 2022 / Revised: 28 September 2022 / Accepted: 29 September 2022 / Published: 3 October 2022
(This article belongs to the Special Issue Clinical Applications of Orthodontic TSADs (Temporary Skeletal Anchorage Devices))
Browse Figures
Versions Notes

Abstract

:
Background: The aim of this study was to evaluate three-dimensional (3D) changes in nasal septal deviation (NSD) and related nasofacial structures after maxillary skeletal expansion (MSE). Methods: This retrospective study evaluated 28 patients aged 12.0–48.4 years (mean age, 20.4 ± 7.3 years; 12 males, 16 females) diagnosed with transverse maxillary deficiency and treated with MSE. Cone-beam computed tomography (CBCT) images were taken at pre-expansion (T1), post-expansion (T2), and 6-months after MSE (T3) and were reoriented. Three-dimensional coordinates (x,y,z) were constructed using nasion (N) as the reference point (0,0,0). A paired-sample t-test and an independent sample t-test were performed to investigate and compare the 3D changes of the NSD and nasofacial structures after MSE, depending on the direction and amount of NSD and the amount of midpalatal expansion (MPE). Results: NSD was alleviated at T3–T1 in the coronal plane; nasal septal length increased significantly. The absolute nasal floor (NF) angle (2.06° at T1) decreased at T2–T1 (p > 0.05) and increased at T3–T2 (p < 0.05). The midface moved forward and downward, and pogonion (Pog) and menton (Me) moved downward and backward. There were no significant differences between the higher and lower NSD groups and greater and lesser MPE groups. Conclusions: Consequently, NSD was alleviated with variable positive nasofacial changes after MSE in both the short and long term. Therefore, MSE can be used to improve or camouflage facial deformities.

1. Introduction

The nasal septum (NS) is the wall that separates the left and right nasal cavities and is composed of the ethmoid bone, vomer, maxilla, and palatine bone. The NS determines the shape and size of the nose and affects midfacial development and facial appearance [1]. Nasal septal deviation (NSD) refers to a curved septum that increases airway resistance and occurs at a rate of 19.5–26% in healthy adults [2]. The etiologies of NSD can be genetic influences, traumas, congenital anomalies, nasal polyps, and tumors or infections [1]. NSD can cause chronic sinus disease, nasal obstruction, snoring, sleep apnea, and facial and dental anomalies, showing a strong relationship with facial growth asymmetry [1,2,3,4,5,6].
Several studies [7,8,9,10,11] have been conducted to evaluate the effects of maxillary expansion on the NS. Schwarz et al. [9] suggested no significant positional change in the NS with surgically-assisted rapid maxillary expansion (SARME). Altug-Atac et al. [7] also proposed that both RME and SARME did not change the position of the NS. On the other hand, Farronato et al. [8] reported that RME improved NSD and increased NS length. Aziz et al. [10] suggested a potentially positive effect of RME on NSD during childhood but no significant change during adolescence. Recently, Mehta et al. [11] concluded that rapid palatal expansion (RPE) and microimplant-assisted RPE (MARPE) significantly improved NSD in the short and long term.
RME is widely used to correct maxillary transverse deficiencies. RME separates the midpalatal suture and expands the maxilla skeletally and dentally, thereby increasing the maxillary width, arch perimeters, and nasal cavity volume, thus reducing nasal airway resistance to improve nasal breathing [7,12,13]. However, a conventional RME has several side effects, including dentoalveolar tipping and a lack of long-term stability [14,15]. In order to improve stability and increase the skeletal effect, a MARPE has recently been developed and is being widely used [11,16,17,18].
MARPE rendered almost parallel palatal expansion antero-posteriorly but showed an asymmetric nasomaxillary expansion at the rate of 30.3–50.0% [16,19,20]. Asymmetric nasomaxillary expansion after MARPE was influenced by initial facial asymmetry with chin deviation, initial asymmetric position of the mid-palatal suture, unilateral crossbite, asymmetric loosening of the circummaxillary suture, and discrepancies in zygomatic bone density and morphology, but it was impossible to predict the amount of asymmetric expansion initially [16,17,19,20].
The three-dimensional analysis of cone-beam computed tomography (CBCT) images have allowed 3D changes of NSD or nasofacial structures to be analyzed after maxillary skeletal expansion (MSE) using direct measurements of angles and lengths on the sectional images, and 3D superimpositions [11,16,17,18,19,20,21,22], while some studies have evaluated the 3D changes using a Cartesian coordinate system [18,23,24]. However, there was no study to evaluate the NSD using a 3D coordinate system. Therefore, the aim of this study was to use 3D coordinates to evaluate the 3D changes in NSD and the related nasofacial structures after MSE.

2. Materials and Methods

2.1. Subjects and Eligibility Criteria

This retrospective study evaluated 28 patients aged 12.0–48.4 years (mean age, 20.4 ± 7.3 years; 12 males, 16 females). The patients were diagnosed as having transverse maxillary deficiency and received orthodontic treatment at Wonkwang University Daejeon Dental Hospital in Daejeon, South Korea. This study was approved by the Institutional Review Board of Wonkwang University Daejeon Dental Hospital (IRB number: W2205/002-001).
The inclusion criteria were as follows: (1) patients who were treated with MSE, (2) the successful opening of the midpalatal suture, and (3) having CBCT images taken at pre-expansion (T1), post-expansion (T2), and 6-months after expansion (T3). The exclusion criteria were as follows: (1) patients with congenital craniofacial anomalies, (2) a history of facial or head trauma, and (3) previous orthodontic or orthopedic treatment and/or orthognathic surgery.
In this study, the same type of MARPE appliance, a maxillary skeletal expander (MSE) (BioMaterials Korea, Seoul, South Korea), was used on all patients. The MSE had four holes and was fixed with four mini-implants (1.5 mm in diameter and 11.0 mm in length). The activation was performed according to the manufacturer’s instructions. The activation rate was 1 turn per day for early teens (<15 years), 2 turns per day for late teens (≥15 years), and 4 turns per day for adult patients (>20 years) before the midpalatal suture opening. Once the diastema was identified, the activation rate was set as 2 turns per day for all patients regardless of age until proper expansion was achieved (Figure 1).
CBCT images were taken at T1, T2, and T3. A CBCT scanner, Alphard-3030 (Asahi Roentgen Ind, Kyoto, Japan), was set at 80 kVp and 7.0 mA for adults, and 80 kVp and 3.0 mA for adolescents. The images were taken in a cranial mode (scan size, 200 × 179 mm; scan time, 17 s; voxel size, 0.39 mm; slice thickness, 1.0 mm).

2.2. Standardized Reorientation of CBCT Images, 3D-Coordinate System, and 3D Measurement

All measurements were observed by an orthodontic resident (H.J.L.). CBCT images were re-oriented, and measurements were made using ON3D (3D ONS, INC., Seoul, South Korea) software. The 3D coordinates (x,y,z) were constructed using nasion (N) as the reference point (0,0,0). They were assigned according to the N point and the FH plane, which was defined as a plane passing through the bilateral orbitale (Or) points and the midpoint of the bilateral porion (Po) points (Figure 2) [21,22]. Three-dimensional landmarks were traced, and each landmark was assigned its 3D coordinates. The three-dimensional landmarks and values are described in Figure 3 and Figure 4 and Table 1 and Table 2.
The three-dimensional values and coordinates were measured at T1, T1, and T3. The measurement planes were designated as a plane containing the most outward deviation of the NS between the anterior nasal spine (ANS) and posterior nasal spine (PNS) horizontally and between the cribriform plate of the ethmoid bone and the palatal process of the maxilla vertically. The direction and amount of NSD were determined by x and lxl of MS in the coronal plane, respectively. Two groups were divided into right (x, negative value) and left (x, positive value), and lower (lxl < 2.5 mm) and higher (lxl ≥ 2.5 mm). Absolute values were used for the x coordinates of the landmarks to obtain the amount of NSD after MSE. The amount of midpalatal expansion (MPE) was determined by dividing the amount of expansion in the ANS and PNS in half, and two groups were divided into lesser (<3.65 mm) and greater (>3.65 mm). All measurements were taken through a 23-inch screen with 1920 × 1080 resolution in a room with a moderate level of light.

2.3. Statistical Analysis

A power analysis using G*Power (version 3.19.2; Franz Faul, Christian-Albrechts-Universitat, Kiel, Germany) was performed to estimate the sample size required for this study. In order to detect the independent sample t-test between group means, effect size and f = 0.90, 24 participants were required to achieve a power exceeding 0.63, p = 0.05.
To assess the reliability of the 3D measurements, CBCT scans of 12 subjects were re-digitized by the same operator and a dentist after 3 weeks. Intra- and interexaminer reliability was assessed by the intra- and interclass correlation coefficients, which showed excellent reliability of 0.938–1.000 and 0.940–1.000, respectively. SPSS software (version 27.0 for Windows; SPSS Corp., Chicago, IL, USA) was used for statistical analyses. A Shapiro-Wilk normality test was performed, and then a non-parametric test was performed when normality was not satisfied. A paired-sample t-test was performed to investigate the three-dimensional changes of the NSD and nasofacial structures after MSE. An independent sample t-test was performed to investigate and compare the three-dimensional changes of the NSD and nasofacial structures after MSE depending on the direction and amount of the NSD, and the amount of MPE. Significance was established at p < 0.05.

3. Results

NSD was alleviated in the coronal plane. NS lengths in the coronal and axial planes significantly increased at T3-T1. LS moved inferiorly at T2-T1 (p < 0.001) and T3-T1 (p < 0.01). MS_A and PS moved posteriorly at T3-T1 (p < 0.05). The angles and widths of the lateral nasal wall (LNW) increased (p < 0.001) at T2-T1 and maintained the increase at T3-T2. The absolute nasal floor (NF) angle (2.06° at T1) decreased at T2-T1 (p > 0.05) but increased at T3-T2 (p < 0.05). LNW and NF moved downward significantly. ANS moved forward and downward significantly. The right and left LF_ANS moved laterally and downward significantly. The mid LF_ANS moved downward (p < 0.01). The Pog and Me moved downward and backward significantly. The Me (lxl, 2.97 mm at T1) moved medially (p > 0.05) at T2-T1 but moved laterally at T3-T2 (p < 0.05), returning back nearly to the T1 value. Go moved backward (p < 0.001). The lzR-zLl of Go increased at T2-T1 (p < 0.01) (Table 3).
In the right NSD group [MS_C(x), −2.50; MS_A(x), −2.35], the LNW angles and widths were greater on the right than on the left. NF showed a left-up canting (NF angle, 1.12° at T1). ANS moved leftward at T3-T1 (p < 0.05). In the left NSD group [MS_C(x), 2.57; MS_A(x), 2.41], the LNW angles and widths were similar on both sides. NF showed a right-up canting (NF angle, −0.83° at T1) (Table 4).
The higher NSD group showed greater US, LS, AS, and PS angles, smaller MS angles than the lower NSD group, and a greater MS (lxl) with a statistical significance. The LNW angles and widths, NF angles, and lxl of ANS, Pog, Me, and Go showed no statistical differences between the higher and lower NSD groups (Table 5A). Most variables showed no statistical differences between the higher and lower NSD groups after MSE (Table 5B).
The amount of MPE was 1.8–5.5 mm (T2-T1, mean amount; 3.6 ± 1.0 mm). The greater MPE group showed greater US, LS, AS, and PS angles, smaller MS angles than the lesser MPE group, and greater AS and MS (lxl) with statistical significances. The LNW angles and widths, NF angles, and lxl of ANS, Pog, Me, and Go showed no statistical differences between the greater and lesser MPE groups (Table 6A). Most variables showed no statistical differences between the greater and lesser MPE groups after MSE (Table 6B).

4. Discussion

In this study, the US angle increased in the short term but decreased in the long term after MSE, which was a slightly different result than what was seen in a previous study [11] that found a significant decrease in the US angle in the short and long term. In the previous studies [3,5,11,25], the authors used the US angle to evaluate NSD. On the other hand, in this study, the MS_C angle significantly increased and the LS angles significantly decreased in the long term, causing the NSD to improve. MS_C and LS angles showed greater changes than the US angle. Therefore, MS_C and LS should be considered when evaluating NSD.
Additionally, in this study, NS angles were measured in the axial plane, which showed the same tendency for NSD improvement as in the coronal plane but greater NSD in the coronal plan than in the axial plane. Absolute values (lxl) of MS in the coronal plane decreased at T3-T1, which meant the NSD improved with the expansion of the maxilla, but the absolute values (lxl) of MS in axial plane were not changed at T3-T1. Therefore, vertical NSD might be more alleviated than horizontal NSD after MSE. Kang et al. [3] and Lee et al. [26] proposed a strong relationship between NSD and facial asymmetry. However, Hartman et al. [27] insisted that NSD was mainly associated with an asymmetry in the nasal floor and palatal region, not with an overall facial asymmetry. Therefore, MSE might decrease NSD, but further studies are needed to evaluate MSE effects on facial asymmetry.
In this study, the vertical NS length increased in the coronal plane after MSE, which was consistent with a previous study [11] that reported a pyriform height increase. Additionally, in this study, the horizontal NS length also increased in the axial plane. These results might be due to the downward movement of LS and posterior movement of MS_A and PS, thereby affecting the NS angles and improving NSD. Farronato et al. [8] suggested that vertical NS length increased in the lower third, improving NSD, which was consistent with the results of this study. Therefore, increasing nasal length in the vertical and horizontal planes might be helpful to alleviate NSD and improve the nasal airway, but further studies are needed to evaluate this.
In this study, LNW widths and angles on both sides increased after MSE, which was consistent with the results of previous studies [11,13,20,28]. Furthermore, the dimensions were greater on the right side than on the left side, and the results that were similar to those in a previous study [3] suggested more frequent facial asymmetry towards the right side of face. In this study, LNW widths and angles had a greater increase on the left side than on the right side at T3-T1 after MSE, which had the effect of reducing nasal asymmetry.
Park et al. [29] reported that nasal floor canting was highly related to NSD and facial asymmetry, and NSD headed towards the lower nasal floor side. Koo et al. [25] suggested that nasal floor canting occurred in the opposite direction to NSD. These findings were consistent with those in our study. Therefore, the direction of the nasal floor canting should be considered when planning to correct facial asymmetry.
The midface moved downward and forward, increasing SNA and ANB angles after MSE in other studies [18,20,28,30,31], which was consistent with our study in which ANS and LF_ANS moved forward and downward. The mandible moved downward and backward after MSE in our study, which was consistent with the results in a previous study [28] in which MARPE caused a clockwise rotation of the mandible, thereby decreasing the SNB angle and increasing anterior facial height. This information might be helpful when planning to treat camouflage skeletal Class III malocclusion with a retruded maxilla and a protruded mandible.
In this study, the ANS and Mid LF_ANS deviation was found to exist in the same direction as NSD. Cantarella et al. [17] reported the asymmetrical expansion of ANS moving more than the contralateral ANS by 1.1 mm, which was consistent with our results but insignificant in our study. On the other hand, an asymmetric maxillary expansion greater than a 1.0 mm difference was observed in 46.4% of the subjects in our study. Kim et al. [19] reported that 30.3% of the subjects treated with tooth-bone-borne RPE showed an asymmetric nasomaxillary expansion. Bazzani et al. [20] reported that 44.0% of asymmetric maxillary expansion occurred after MARPE. Almaqrami et al. [16] reported that the presence of an asymmetric mid-palatal suture was the main causative factor of asymmetric maxillary expansion, and 46.9% of patients showed an asymmetric maxillary expansion of 1.0 mm or more after MARPE, which was consistent with our study. However, the reason why the maxilla expanded asymmetrically in the transverse direction after MSE has not been clearly elucidated. Therefore, asymmetric expansion should be carefully considered before maxillary expansion.
On the contrary, the transverse asymmetry of the mandible (Pog, Me, and Go) was slightly alleviated after MSE in this study. Evangelista et al. [32] reported that craniofacial asymmetry was alleviated in the long term, but this was not consistent with the findings in our study that showed improvement of the mandibular asymmetry in the short term but a regression back to the T1 value in the long term. The results from the other study might have differed from those in our study because the previous study [32] evaluated the mandibular changes after RME in growing patients, while our study looked at the mandibular changes after MSE in both growing and non-growing patients.
The small sample size limited this study to evaluate the NSD and nasofacial changes according to age, gender, skeletal pattern, and asymmetry, and soft tissue was not included in the evaluation. We have attempted to compare as many variables as possible to evaluate NSD. However, we could not obtain the sample size to improve the statistical verification. Therefore, further studies might be needed with a larger sample size and soft tissue measurements.
These days, MSE is widely used for several purposes, such as maxillary expansion, anchorage for a facemask, total mesialization and distalization of the dentition, and changing the three-dimensional adjacent craniofacial structures. According to the results from this study, variable positive nasofacial changes will occur after MSE. Therefore, more studies would be helpful to improve or camouflage facial deformities.

5. Conclusions

Within the limitations of this study, NSD was alleviated with variable positive nasofacial changes in the short and long term after MSE, as outlined below.
  • Changes in MS_C and LS angles improved NSD more than changes in the US angle.
  • Vertical and horizontal NS length increased significantly.
  • NF canting was in the opposite direction to NSD.
  • The frequency of asymmetric maxillary expansion greater than 1.0 mm was 46.4%, but the amount of asymmetric maxillary expansion was not statistically significant.
  • LNW, NF, ANS, and LF_ANS moved forward and downward.
  • Pog, Me, and Go moved downward and backward.
  • There were no significant differences between the higher and lower NSD groups and the greater and lesser MPE groups.
Consequently, MSE can be used to improve or camouflage facial deformities.

Author Contributions

Conceptualization, H.-J.L. and J.H.P.; methodology, H.-J.L.; software, S.-K.C.; validation, N.-Y.C. and K.-H.K.; formal analysis, H.Y.S.; investigation, H.-J.L.; resources, S.-K.C.; data curation, H.Y.S.; writing—original draft preparation, H.-J.L. and J.H.P.; writing—review and editing, J.H.P. and J.-M.C.; visualization, N.-Y.C. and K.-H.K.; supervision, J.-M.C.; project administration, J.-M.C. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

This study was approved by the Institutional Review Board of Wonkwang University Daejeon Dental Hospital (W2205/002-001).

Informed Consent Statement

Written informed consent was obtained from the patient for publication of this short report and any accompanying images.

Data Availability Statement

The authors declare that the materials are available.

Acknowledgments

This paper was supported by Wonkwang University in 2022.

Conflicts of Interest

The authors declare no conflict of interest.

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Applsci 12 09949 g001 550
Figure 1. Maxillary skeletal expander. (A) Pre-expansion, (B) Post-expansion.
Figure 1. Maxillary skeletal expander. (A) Pre-expansion, (B) Post-expansion.
Applsci 12 09949 g001
Applsci 12 09949 g002 550
Figure 2. The 3-dimensional coordinate system and standardized reorientation of CBCT Images. (A) Frontal view. (B) Oblique view. The coordinate system consists of three axes (x, y, and z) with their origin (0,0,0) registered at nasion (N). Frankfort horizontal plane (FH plane) was constructed with bilateral orbitale (Or) points and the midpoint of bilateral porion (Po) points. The x-axis is a transverse axis passing through the N point and also parallel to the FH plane in the frontal view. The y-axis is the anteroposterior axis passing through the N point and perpendicular to the x-axis. The y-axis is parallel to the FH plane in the sagittal plane. The z-axis is the vertical axis perpendicular to both x- and y-axes. Positive values are to the left, posterior, and superior (LPS) to the N point of the subject. Negative values are to the right, anterior, and inferior (RAI) to the N point. PoMP, midpoint of bilateral porion (Po) points. Rt, right. Lt, left.
Figure 2. The 3-dimensional coordinate system and standardized reorientation of CBCT Images. (A) Frontal view. (B) Oblique view. The coordinate system consists of three axes (x, y, and z) with their origin (0,0,0) registered at nasion (N). Frankfort horizontal plane (FH plane) was constructed with bilateral orbitale (Or) points and the midpoint of bilateral porion (Po) points. The x-axis is a transverse axis passing through the N point and also parallel to the FH plane in the frontal view. The y-axis is the anteroposterior axis passing through the N point and perpendicular to the x-axis. The y-axis is parallel to the FH plane in the sagittal plane. The z-axis is the vertical axis perpendicular to both x- and y-axes. Positive values are to the left, posterior, and superior (LPS) to the N point of the subject. Negative values are to the right, anterior, and inferior (RAI) to the N point. PoMP, midpoint of bilateral porion (Po) points. Rt, right. Lt, left.
Applsci 12 09949 g002
Applsci 12 09949 g003 550
Figure 3. The 3-dimensional landmarks. (A) Nasal landmarks on the coronal section passing through the most deviated point in the nasal septum. (B) Nasal landmarks on the axial section passing through the most deviated point in the nasal septum. (C) Maxillary landmarks on the axial section passing through ANS. (D) Mandibular landmarks on the frontal view. Rt, right; Lt, left; US, upper septum; MS_C, middle septum_coronal; LS, lower septum; LNW, lateral nasal wall; NF, nasal floor; AS, anterior septum; MS_A, middle septum_axial; PS, posterior septum; ANS, anterior nasal spine; LF_ANS, lateral fossa_ANS; N, nasion; Pog, pogonion; Me, menton; Go, gonion.
Figure 3. The 3-dimensional landmarks. (A) Nasal landmarks on the coronal section passing through the most deviated point in the nasal septum. (B) Nasal landmarks on the axial section passing through the most deviated point in the nasal septum. (C) Maxillary landmarks on the axial section passing through ANS. (D) Mandibular landmarks on the frontal view. Rt, right; Lt, left; US, upper septum; MS_C, middle septum_coronal; LS, lower septum; LNW, lateral nasal wall; NF, nasal floor; AS, anterior septum; MS_A, middle septum_axial; PS, posterior septum; ANS, anterior nasal spine; LF_ANS, lateral fossa_ANS; N, nasion; Pog, pogonion; Me, menton; Go, gonion.
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Applsci 12 09949 g004 550
Figure 4. The 3-dimensional values. (A) Nasal septal angles (US, MS_C, and LS) in the coronal plane. (B) Nasal septal angles (AS, MS_A, and PS) in the axial plane. (C) Lateral nasal wall (LNW) angles and widths, and nasal floor (NF) angle. (D) Nasal septal length (NSL) in the coronal plane (between US and LS). (E) NSL in the axial plane (between AS and PS). Rt, right. Lt, left.
Figure 4. The 3-dimensional values. (A) Nasal septal angles (US, MS_C, and LS) in the coronal plane. (B) Nasal septal angles (AS, MS_A, and PS) in the axial plane. (C) Lateral nasal wall (LNW) angles and widths, and nasal floor (NF) angle. (D) Nasal septal length (NSL) in the coronal plane (between US and LS). (E) NSL in the axial plane (between AS and PS). Rt, right. Lt, left.
Applsci 12 09949 g004
Table
Table 1. Definitions of 3-dimensional landmarks.
Table 1. Definitions of 3-dimensional landmarks.
LandmarksDefinitions
Cranial Base landmarks
N (Nasion)The most medial and superior point of the frontonasal suture
Or (Orbitale)The most inferior point of the orbital rim
Po (Porion)The most superior point of the external auditory meatus
Nasal landmarks
US (upper septum)The point where the nasal septum and cribriform plate met in the coronal measurement plane
MS_C (middle septum_coronal)The outermost point of the nasal septum in the coronal measurement plane
LS (lower septum)The point where the nasal septum and palate met in the coronal measurement plane
AS (anterior septum)The most anterior point of the nasal septum in the axial measurement plane
MS_A (middle septum_axial)The outermost point of the nasal septum in the axial measurement plane
PS (posterior septum)The most distal point of the nasal septum in the axial measurement plane
LNW (lateral nasal wall)The outermost point of the lateral nasal wall in the coronal measurement plane
NF (nasal floor)The lowest point of the nasal cavity in the coronal measurement plane
Maxillary landmarks
ANS (Anterior nasal spine)The most anterior point of the premaxillary bone in the sagittal plane
LF_ANSThe most concave point of the lateral fossa of the maxilla
Mandibular landmarks
Pog (Pogonion)The most anterior point in the mandibular chin area in the sagittal plane
Me (Menton)The lowermost point on the symphysis menti in the sagittal and coronal plane
Go (Gonion)The point in the inferoposterior outline of the mandible at which the surface turns from the inferior border into the posterior border in the sagittal plane
Table
Table 2. Definitions of 3-dimensional values.
Table 2. Definitions of 3-dimensional values.
ValuesDefinitions
US angle (°)The angle between US and sagittal line passing through US
MS_C angle (°)The angle between US, MS_C and LS
LS angle (°)The angle between LS and sagittal line passing through LS
US-LS (mm) The length between US and LS
US (x,y,z) The x,y,z coordinate values of US
MS_C (x,y,z) The x,y,z coordinate values of MS_C
LS (x,y,z) The x,y,z coordinate values of LS
AS angle (°)The angle between AS and sagittal line passing through AS
MS_A angle (°)The angle between AS, MS_A and PS
PS angle (°)The angle between PS and sagittal line passing through PS
AS-PS (mm)The length between AS and PS
AS (x,y,z) The x,y,z coordinate values of AS
MS_A (x,y,z) The x,y,z coordinate values of MS_A
PS (x,y,z) The x,y,z coordinate values of PS
LNW angle (°)Angle between LNW and sagittal line passing through US
NF angle (°)The angle between NF and axial line
ANS (x,y,z) The x,y,z coordinate values of ANS
LF_ANS (x,y,z)The x,y,z coordinate values of LF_ANS
Mid LF_ANS (x,y,z)The x,y,z coordinate values of Mid LF_ANS
Pog (x,y,z)The x,y,z coordinate values of Pog
Me (x,y,z)The x,y,z coordinate values of Me
Go (x,y,z)The x,y,z coordinate values of Go
Table
Table 3. Three-dimensional values and changes of nasal septum and nasofacial structures after MSE.
Table 3. Three-dimensional values and changes of nasal septum and nasofacial structures after MSE.
Variables T1 (n = 28)T2 (n = 28)T3 (n = 28)T2-T1 (n = 28)T3-T2 (n = 28)T3-T1 (n = 28)
Nasal Septum MeanSDMeanSDMeanSDMeanSDp-ValueMeanSDp-ValueMeanSDp-Value
CoronalAngleUS(°)4.822.385.072.504.872.520.260.830.113−0.211.320.414 0.05 1.49 0.858
MS(°)166.707.19166.057.56168.117.67−0.652.610.1972.073.850.009 **1.41 3.66 0.051
LS(°)8.405.438.925.646.915.790.512.290.245−2.013.210.003 **−1.49 2.99 0.014 *
LengthUS-LS(mm)47.163.4147.873.3447.823.390.710.920.000 ***−0.051.420.852 0.66 1.09 0.004 **
AxialAngleAS(°)4.232.994.262.914.122.980.031.070.889−0.141.100.507 −0.11 1.15 0.613
MS(°)171.276.54171.476.20171.476.680.201.490.4930.001.520.987 0.20 1.94 0.589
PS(°)5.164.164.963.815.104.28−0.211.000.2870.151.580.631 −0.06 1.44 0.826
LengthAS-PS(mm)64.737.3764.997.3065.637.050.261.000.1880.641.820.076 0.89 1.99 0.025 *
Coronalx,y,zUSlxl0.700.560.690.630.720.60−0.020.400.8130.030.400.698 0.01 0.24 0.806
y26.837.2326.767.0026.837.15−0.071.310.7650.071.780.835 0.00 1.06 0.984
z−5.763.43−5.623.33−5.843.520.130.560.219−0.220.780.149 −0.09 0.49 0.358
x,y,zMSlxl2.521.312.591.312.381.440.060.460.484−0.200.840.214 −0.14 0.77 0.343
y26.837.2326.767.0026.847.16−0.071.310.7650.081.750.800 0.01 1.03 0.959
z−35.314.46−35.324.76−35.434.55−0.010.850.972−0.111.370.672 −0.12 0.89 0.492
x,y,zLSlxl1.170.891.210.891.070.660.040.640.724−0.150.770.323 −0.10 0.54 0.326
y26.837.2326.767.0026.837.15−0.071.310.7650.071.780.835 0.00 1.06 0.984
z−52.913.51−53.483.53−53.653.37−0.580.710.000 ***−0.171.220.474 −0.75 1.09 0.001 **
Axialx,y,zAS lxl1.311.141.210.851.141.01−0.100.540.350−0.070.500.495 −0.16 0.51 0.099
y−12.475.32−12.475.20−12.575.140.000.780.998−0.101.110.624 −0.10 1.28 0.670
z−38.334.31−38.184.14−38.234.390.150.880.375−0.051.480.859 0.10 1.24 0.673
x,y,zMSlxl2.371.462.411.472.371.540.040.430.620−0.050.380.536 0.00 0.37 0.956
y24.436.7824.886.4325.146.370.441.290.0810.261.600.394 0.70 1.61 0.028 *
z−38.334.31−38.264.18−38.234.400.070.710.6240.031.480.915 0.10 1.23 0.683
x,y,zPSlxl1.431.151.561.191.421.130.130.580.264−0.140.570.207 −0.01 0.31 0.825
y52.214.6152.474.2753.014.670.261.190.2660.541.910.147 0.80 1.91 0.036 *
z−38.334.31−35.4015.13−38.234.392.9314.710.302−2.8314.740.319 0.10 1.24 0.673
Lateral nasal wallAngleRight(°)23.772.5125.002.5324.892.291.220.860.000 ***−0.110.800.464 1.11 0.72 0.000 ***
Left(°)23.502.6124.512.4924.542.611.021.040.000 ***0.031.080.875 1.05 0.96 0.000 ***
x,y,zRight x−16.591.68−17.771.86−17.711.61−1.170.790.000 ***0.060.800.700−1.11 0.60 0.000 ***
y26.837.2326.767.0026.837.15−0.071.310.760.071.780.8350.00 1.06 0.984
z−43.293.98−43.653.88−43.893.83−0.360.950.06−0.251.130.260−0.61 0.96 0.002 **
x,y,zLeft x15.992.1317.142.0117.152.051.150.630.000 ***0.010.630.9401.15 0.70 0.000 ***
y26.837.2326.767.0026.837.15−0.071.310.760.071.780.8350.00 1.06 0.984
z−43.024.22−43.643.97−43.814.27−0.621.010.003 **−0.171.460.542−0.79 1.29 0.003 **
Nasal floorAnglel°l2.061.071.721.502.271.50−0.331.320.1930.541.250.029 *0.21 1.54 0.471
Right x−8.582.21−9.722.19−9.412.28−1.150.870.000 ***0.320.920.08−0.83 1.16 0.000 ***
y26.837.2326.767.0026.837.15−0.071.310.760.071.780.840.00 1.06 0.984
z−53.743.75−54.263.69−54.623.65−0.520.580.000 ***−0.360.830.028 *−0.88 0.98 0.000 ***
Left x8.152.149.322.259.102.381.170.820.000 ***−0.220.950.240.95 0.93 0.000 ***
y26.837.2326.767.0026.837.15−0.071.310.760.071.780.840.00 1.06 0.984
z−53.674.02−54.133.99−54.613.91−0.460.650.000 ***−0.480.870.006 **−0.94 1.19 0.000 ***
Antterior nasal spine (ANS)lxl0.950.871.040.801.130.790.090.580.4340.100.510.313 0.19 0.52 0.070
y−1.893.77−1.933.91−2.424.04−0.050.790.755−0.481.180.039 *−0.53 1.18 0.025 *
z−53.614.10−54.133.95−54.203.73−0.520.780.002 *−0.070.740.616 −0.59 0.87 0.001 **
LF_ANSRight x−10.182.09−11.691.99−12.022.19−1.510.840.000 ***−0.320.950.084 −1.84 1.27 0.000 ***
y7.513.897.474.047.383.97−0.040.610.723−0.090.720.515 −0.13 0.98 0.484
z−53.614.10−54.133.95−54.183.77−0.520.780.002 **−0.040.800.771 −0.56 0.87 0.002 **
Left x10.032.6111.622.6111.842.411.591.000.000 ***0.230.940.211 1.81 1.35 0.000 ***
y7.483.607.603.767.493.570.120.820.447−0.110.650.377 0.01 1.00 0.963
z−53.614.10−54.133.95−54.203.73−0.520.780.002 **−0.070.740.616 −0.59 0.87 0.001 **
Middle lxl0.810.840.840.840.770.870.030.390.686−0.070.390.351 −0.04 0.43 0.628
y7.503.727.543.887.443.750.040.670.759−0.100.650.416 −0.06 0.95 0.735
z−53.614.10−54.133.95−54.193.75−0.520.780.002 **−0.060.770.691 −0.58 0.86 0.001 **
Pogonion (Pog)lxl2.821.932.622.202.802.20−0.200.970.2880.180.930.325 −0.02 0.81 0.886
y1.738.333.338.362.998.321.601.250.000 ***−0.341.580.266 1.26 1.68 0.000 ***
z−113.708.20−114.767.86−114.657.58−1.061.120.000 ***0.111.980.767 −0.95 2.09 0.023 *
Menton (Me)lxl2.972.082.642.393.052.44−0.330.970.0880.411.030.047 *0.08 0.92 0.649
y7.198.598.798.418.468.521.601.250.000 ***−0.331.490.258 1.27 1.62 0.000 ***
z−120.048.14−120.937.85−120.997.52−0.901.080.000 ***−0.061.830.861 −0.96 1.98 0.016 *
Gonion (Go)Rightx−47.743.36−48.003.40−47.843.26−0.260.900.1330.161.060.430 −0.10 0.85 0.524
y70.425.6871.486.0871.555.291.061.200.000 ***0.061.770.848 1.13 1.07 0.000 ***
z−86.897.58−86.697.81−87.037.720.211.210.371−0.351.710.295 −0.14 1.61 0.654
Leftx47.474.3147.454.4147.614.66−0.020.880.8830.161.040.420 0.14 1.01 0.477
y69.845.6771.045.5671.025.321.201.040.000 ***−0.021.240.934 1.18 1.16 0.000 ***
z−86.217.59−85.987.59−86.187.430.231.010.239−0.211.440.455 0.02 1.30 0.923
lRight-LeftllxR-xLl3.522.223.222.613.302.70−0.301.180.1950.081.390.776 −0.22 1.17 0.327
lyR-yLl1.931.392.091.732.021.280.161.340.526−0.071.240.761 0.09 0.56 0.399
lzR-zLl1.781.842.242.002.062.100.460.790.005 **−0.180.910.299 0.28 0.87 0.102
T1, pre-expansion; T2, post-expansion; T3, 6 months after expansion. The coordinate system consists of three axes (x, y, and z) with their origin (0,0,0) registered at nasion (N). Positive values are to the left, posterior, and superior (LPS) to the N point of the subject. Negative values are to the right, anterior, and inferior (RAI) to the N point. MSE, maxillary skeletal expansion. lxl, absolute value of x. * p < 0.05, ** p < 0.01, *** p < 0.001. A paired t-test was performed.
Table
Table 4. Three-dimensional values and changes of nasal septum and nasofacial structures after MSE depending on the direction of NSD.
Table 4. Three-dimensional values and changes of nasal septum and nasofacial structures after MSE depending on the direction of NSD.
A. Right NSD Group T1 (n = 18)T2 (n = 18)T3 (n = 18)T2-T1 (n = 18)T3-T2 (n = 18)T3-T1 (n = 18)
MeanSDMeanSDMeanSDMeanSDp-ValueMeanSDp-ValueMeanSDp-Value
Nasal septumCoronal US x−0.120.83−0.060.94−0.060.880.060.430.5830.000.440.9870.06 0.31 0.405
MS x−2.501.46−2.551.40−2.081.99−0.050.490.6540.471.410.1780.38 1.37 0.255
LSx−0.211.420.011.49−0.231.230.220.790.251−0.241.010.326−0.01 0.56 0.928
Axial AS x0.311.050.521.000.340.970.210.520.111−0.180.570.1980.03 0.55 0.825
MS x−2.351.66−2.461.63−2.341.73−0.100.440.3310.110.440.288−0.01 0.42 0.929
PS x−0.401.75−0.651.95−0.391.81−0.250.730.1700.260.750.1650.00 0.31 0.953
Lateral nasal wallAngleRight(°)24.252.7425.552.7125.372.401.310.860.000 ***−0.180.950.4231.12 0.67 0.000 ***
Left(°)23.852.7424.732.7524.762.830.881.000.001 **0.031.100.9120.91 1.02 0.001 **
x,y,zRightx−16.661.63−17.821.96−17.751.49−1.16 0.89 0.000 ***0.08 0.94 0.740 −1.09 0.50 0.000 ***
y27.197.7927.087.7627.167.98−0.05 1.37 0.747 0.08 2.17 0.883 0.03 1.11 0.924
z−42.593.95−42.813.88−43.213.69−0.23 0.93 0.314 −0.40 1.23 0.188 −0.63 0.93 0.011 *
x,y,zLeftx15.892.1017.042.0016.991.981.15 0.62 0.000 ***−0.05 0.62 0.738 1.10 0.62 0.000 ***
y27.197.9027.087.7627.167.98−0.11 1.37 0.747 0.08 2.17 0.883 −0.03 1.11 0.924
z−41.903.66−42.733.46−42.813.64−0.82 1.05 0.004 **−0.08 1.53 0.818 −0.90 1.33 0.010 *
Nasal floor Angle(°)1.121.931.241.950.652.560.121.300.706−0.581.430.103−0.46 2.35 0.414
l°l2.010.881.831.372.161.44−0.181.170.5160.331.280.2840.15 1.51 0.677
Rightx−8.732.37−9.742.37−9.402.27−1.01 0.89 0.000 ***0.34 0.91 0.135 −0.67 0.96 0.009 **
y27.197.9027.087.7626.619.00−0.11 1.37 0.747 −0.48 3.28 0.883 −0.59 2.67 0.924
z−52.893.20−53.543.33−53.893.13−0.65 0.52 0.000 ***−0.35 0.99 0.149 −1.00 1.11 0.001 **
Leftx8.391.889.642.009.282.071.25 0.76 0.000 ***−0.36 1.10 0.188 0.89 0.85 0.000 ***
y27.197.9027.087.7627.167.98−0.11 1.37 0.747 0.08 2.17 0.883 −0.03 1.11 0.924
z−52.643.40−53.163.38−53.673.26−0.52 0.51 0.000 ***−0.51 1.07 0.057 −1.03 1.34 0.004 **
Anterior nasal spine (ANS)x−0.130.99−0.120.980.101.050.010.510.9600.220.760.2250.28 0.53 0.037 *
LF_ANSRightx−10.032.11−11.642.13−11.852.41−1.610.910.000 ***−0.210.870.317−1.94 1.08 0.000 ***
Leftx9.382.7210.962.7811.042.501.581.060.000 ***0.080.890.7161.79 1.15 0.000 ***
Middlex−0.320.85−0.340.86−0.400.81−0.010.450.890−0.070.630.657−0.08 0.58 0.592
Pogonion (Pog)x−0.483.69−0.453.69−0.553.880.031.150.925−0.101.100.712−0.18 0.82 0.359
Menton (Me)x−0.483.96−0.563.90−0.324.32−0.081.240.7780.241.420.4760.03 0.93 0.899
Gonion (Go)Right x−47.523.57−47.803.65−47.583.44−0.281.070.2890.231.210.439−0.13 0.84 0.527
Left x46.483.7346.543.5446.784.120.060.910.7730.241.260.4320.28 1.07 0.292
B. Left NSD Group T1 (n = 10)T2 (n = 10)T3 (n = 10)T2-T1 (n = 10)T3-T2 (n = 10)T3-T1 (n = 10)
x,y,zMeanSDMeanSDMeanSDMeanSDp-ValueMeanSDp-ValueMeanSDp-Value
Nasal septumCoronal US x−0.251.04−0.250.96−0.281.050.000.470.984 −0.040.520.828 −0.03 0.14 0.447
MS x2.571.042.651.212.341.270.080.440.584 −0.311.280.465 −0.23 1.22 0.564
LSx−0.491.57−0.481.59−0.011.380.010.610.944 0.470.500.017 *0.48 0.61 0.034 *
Axial AS x0.742.520.661.950.682.14−0.080.660.705 0.020.460.894 −0.06 0.54 0.727
MS x2.411.092.341.182.351.34−0.070.430.619 0.010.440.950 −0.06 0.30 0.530
PS x−0.601.96−0.531.86−0.441.840.060.370.605 0.090.360.448 0.15 0.20 0.039 *
Lateral nasal wallAngleRight(°)22.921.8524.001.9124.021.891.080.900.004 **0.010.450.917 1.09 0.84 0.002 **
Left(°)22.862.3524.122.0124.162.241.261.120.006 **0.041.100.915 1.29 0.84 0.000 ***
x,y,zRightx−16.471.83−17.671.76−17.641.88−1.20 0.62 0.000 ***0.03 0.47 0.849 −1.17 0.77 0.001 **
y26.196.1926.175.7026.235.69−0.02 1.25 0.962 0.06 0.80 0.814 0.04 1.01 0.898
z−44.553.91−45.153.58−45.123.97−0.60 0.99 0.088 0.03 0.92 0.925 −0.57 1.06 0.124
x,y,zLeftx16.182.2717.322.1317.442.241.14 0.66 0.000 ***0.11 0.67 0.602 1.26 0.87 0.001 **
y26.196.1926.175.7026.235.69−0.02 1.25 0.962 0.06 0.80 0.814 0.04 1.01 0.898
z−45.034.59−45.284.47−45.614.92−0.25 0.86 0.376 −0.32 1.39 0.479 −0.58 1.25 0.178
Nasal floor Angle(°)−0.832.50−0.942.19−1.192.81−0.111.850.849 −0.251.540.624 −0.36 1.90 0.563
l°l2.131.391.531.782.451.67−0.601.580.259 0.921.160.032 *0.32 1.66 0.554
Rightx−8.301.97−9.701.93−9.422.43−1.40 0.82 0.000 ***0.28 0.98 0.384 −1.12 1.46 0.038 *
y26.196.1926.175.7026.235.69−0.02 1.25 0.962 0.06 0.80 0.814 0.04 1.01 0.898
z−55.274.32−55.554.12−55.944.29−0.28 0.65 0.205 −0.39 0.48 0.031 *−0.67 0.68 0.013 *
Leftx7.722.608.752.668.782.951.03 0.95 0.007 **0.03 0.55 0.858 1.06 1.09 0.013 *
y26.196.1926.175.7026.235.69−0.02 1.25 0.962 0.06 0.80 0.814 0.04 1.01 0.898
z−55.534.53−55.884.58−56.324.57−0.35 0.88 0.242 −0.44 0.37 0.004 **−0.78 0.91 0.023 *
Anterior nasal spine (ANS)x0.641.650.751.660.901.700.100.870.716 0.150.670.490 0.26 0.64 0.236
LF_ANSRightx−10.452.13−11.801.80−12.321.78−1.340.720.000 ***−0.521.090.166 −1.86 1.42 0.003 **
Leftx11.202.0512.791.8413.291.411.600.950.000 ***0.501.000.152 2.09 1.44 0.001 **
Middlex0.371.550.501.550.491.500.130.480.419 −0.010.530.940 0.12 0.51 0.492
Pogonion (Pog)x1.262.831.382.761.472.740.120.670.572 0.090.690.690 0.21 0.66 0.329
Menton (Me)x1.262.911.352.741.612.900.100.790.708 0.260.500.143 0.35 0.51 0.055
Gonion (Go)Rightx−48.123.08−48.363.05−48.323.03−0.240.510.169 0.040.760.862 −0.20 0.71 0.403
Leftx49.264.9149.075.4949.105.41−0.180.840.508 0.020.500.886 −0.16 0.80 0.545
T1, pre-expansion; T2, post-expansion; T3, 6 months after expansion. The coordinate system consists of three axes (x, y, and z) with their origin (0,0,0) registered at nasion (N). Positive values are to the left, posterior, and superior (LPS) to the N point of the subject. Negative values are to the right, anterior, and inferior (RAI) to the N point. MSE, maxillary skeletal expansion. lxl, absolute value of x. * p < 0.05, ** p < 0.01, *** p < 0.001. A paired t-test was performed.
Table
Table 5. Three-dimensional values (A) and changes (B) of nasal septum and nasofacial structures after MSE depending on the amount of NSD.
Table 5. Three-dimensional values (A) and changes (B) of nasal septum and nasofacial structures after MSE depending on the amount of NSD.
(A)
Variables T1 (n = 28)T2 (n = 28)T3 (n = 28)
NSDNSD < 2.5 mm (n = 14)NSD ≥ 2.5 mm (n = 14) NSD < 2.5 mm (n = 14)NSD ≥ 2.5 mm (n = 14) NSD < 2.5 mm (n = 14)NSD ≥ 2.5 mm (n = 14)
Nasal Septumx,y,zMeanSDMeanSDp-ValueMeanSDMeanSDp-ValueMeanSDMeanSDp-Value
CoronalAngleUS(°)3.271.906.361.740.000 ***3.602.426.551.560.001 **3.542.056.192.270.003 **
MS(°)171.444.68161.956.070.000 ***170.495.81161.606.510.001 **172.554.33163.677.800.001 **
LS(°)5.273.6411.545.190.001 **5.874.3211.975.240.002 **3.533.1310.305.930.001 **
LengthUS-LS(mm)47.423.2446.913.680.69847.843.4747.903.330.96348.033.2647.603.620.744
AxialAngleAS(°)2.451.696.022.980.001 **2.831.895.703.090.007 **2.471.915.772.990.002 **
MS(°)174.524.03168.037.070.006 **174.394.11168.556.670.010 *174.654.92168.306.830.009 **
PS(°)3.503.026.834.570.031 *3.322.606.594.200.020 *3.303.176.914.580.023 *
LengthAS-PS(mm)67.248.8362.234.620.07167.718.7262.274.310.047 *68.188.1163.074.830.053
CoronalUSlxl0.710.430.700.690.9870.770.580.600.690.4830.720.500.710.700.961
MSlxl1.440.593.610.810.000 ***1.540.593.630.940.000 ***1.400.613.371.350.000 ***
LSlxl1.070.791.270.990.5721.340.751.091.020.4670.990.511.150.800.549
AxialAS lxl1.160.851.461.390.5041.180.781.240.940.8661.140.961.151.090.967
MSlxl1.390.703.361.370.000 ***1.520.733.311.490.001 **1.420.823.321.520.000 ***
PS lxl1.240.901.621.360.3851.440.981.671.410.6321.270.981.571.290.489
Lateral nasal wallAngleRight(°)23.573.4223.981.140.67525.093.2924.911.580.85524.743.0725.031.190.748
Left(°)24.142.5922.852.550.19325.102.5123.922.400.21424.872.5624.222.710.524
x,y,zRightx−16.261.74−16.931.600.303−17.602.14−17.931.600.642 −17.26 1.50 −18.16 1.64 0.140
y27.597.3126.087.340.58927.467.3026.066.880.606 27.57 7.31 26.09 7.18 0.593
z−43.854.87−42.732.920.469−44.144.71−43.162.940.516 −44.22 4.63 −43.56 2.97 0.657
x,y,zLeftx16.742.1115.251.930.06217.672.1116.611.840.168 17.63 2.09 16.66 1.96 0.218
y27.597.3126.087.340.58927.467.3026.066.880.606 27.57 7.31 26.09 7.18 0.593
z−43.554.86−42.493.560.519−44.204.76−43.073.070.461 −44.17 4.88 −43.45 3.72 0.663
Nasal floorAnglel°l1.881.022.231.120.3951.911.481.541.550.5172.311.312.221.720.880
Rightx−8.091.97−9.062.400.251−9.161.96−10.282.320.179 −8.67 1.92 −10.14 2.44 0.089
y27.597.3126.087.340.58927.467.3026.066.880.606 27.57 7.31 26.09 7.18 0.593
z−54.194.11−53.293.430.531−54.694.03−53.833.400.543 −55.02 4.19 −54.22 3.12 0.571
Leftx8.792.197.511.970.1159.882.478.761.940.192 9.70 2.56 8.51 2.11 0.189
y27.597.3126.087.340.58927.467.3026.066.880.606 27.57 7.31 26.09 7.18 0.593
z−53.904.43−53.443.710.766−54.254.30−54.003.830.871 −54.65 4.30 −54.58 3.65 0.960
Antterior nasal spine (ANS)lxl0.820.701.071.030.4581.040.821.030.800.9911.140.811.130.810.993
LF_ANSMiddle lxl0.690.740.930.930.4510.740.680.940.990.5430.610.770.930.960.339
Pogonion (Pog)lxl2.401.903.251.930.2502.261.942.982.450.3982.502.163.102.270.477
Menton (Me)lxl2.541.983.402.160.2842.322.132.972.660.4812.712.293.392.620.473
Gonion (Go)lRight-LeftllxR-xLl3.762.363.282.130.5733.362.833.092.480.7913.683.202.922.160.467
lyR-yLl1.631.302.231.460.2602.232.021.951.440.6761.651.282.401.210.124
lzR-zLl1.711.531.852.170.8492.121.802.362.250.7551.951.692.162.510.795
(B)
T2-T1 (n = 28)T3-T2 (n = 28)T3-T1 (n = 28)
VariablesNSDNSD < 2.5 mm (n = 14)NSD ≥ 2.5 mm (n = 14) NSD < 2.5 mm (n = 14)NSD ≥ 2.5 mm (n = 14) NSD < 2.5 mm (n = 14)NSD ≥ 2.5 mm (n = 14)
Nasal Septumx,y,zMeanSDMeanSDp-ValueMeanSDMeanSDp-ValueMeanSDMeanSDp-Value
CoronalAngleUS(°)0.320.710.190.970.688−0.060.84−0.361.700.561 0.27 0.69 −0.16 2.01 0.457
MS(°)−0.952.69−0.352.600.5532.062.372.075.020.995 1.11 1.88 1.72 4.91 0.670
LS(°)0.602.430.432.230.851−2.352.30−1.673.980.585 −1.75 2.23 −1.24 3.67 0.659
LengthUS-LS(mm)0.420.761.001.000.0990.201.66−0.301.140.369 0.62 1.25 0.70 0.96 0.843
AxialAngleAS(°)0.380.83−0.321.190.085−0.361.260.080.910.305 0.02 0.90 −0.24 1.37 0.556
MS(°)−0.130.800.521.940.2660.261.41−0.251.640.383 0.14 1.67 0.27 2.24 0.862
PS(°)−0.171.02−0.241.020.873−0.021.860.311.280.585 −0.20 1.46 0.08 1.45 0.626
LengthAS-PS(mm)0.461.100.050.880.2790.472.420.800.990.646 0.94 2.70 0.85 0.93 0.906
CoronalUSlxl0.070.47−0.100.310.279−0.050.420.110.360.293 0.02 0.30 0.01 0.16 0.932
MSlxl0.100.490.020.440.655−0.140.52−0.271.090.695 −0.04 0.31 −0.24 1.05 0.485
LSlxl0.270.62−0.180.610.066−0.350.790.060.720.168 −0.08 0.58 −0.12 0.53 0.850
AxialAS lxl0.020.50−0.220.580.254−0.050.58−0.090.430.840 −0.02 0.46 −0.30 0.53 0.150
MSlxl0.130.41−0.050.450.298−0.100.380.010.390.485 0.03 0.31 −0.04 0.43 0.624
PS lxl0.210.710.040.430.470−0.180.75−0.100.330.715 0.03 0.27 −0.05 0.35 0.497
Lateral nasal wallAngleRight(°)1.520.630.930.980.071−0.340.770.120.790.126 1.17 0.68 1.05 0.78 0.660
Left(°)0.961.111.071.000.775−0.241.030.301.090.190 0.72 1.03 1.38 0.78 0.069
x,y,zRightx−1.340.85−1.010.720.2820.340.90−0.220.580.058 −1.00 0.54 −1.23 0.65 0.302
y−0.131.45−0.021.190.8220.112.450.030.770.908 −0.02 1.26 0.01 0.86 0.935
z−0.290.79−0.431.110.708−0.091.31−0.400.940.470−0.381.10−0.830.770.218
x,y,zLeftx0.930.661.360.530.067−0.040.560.060.710.701 0.89 0.57 1.42 0.74 0.046 *
y−0.131.45−0.021.190.8220.112.450.030.770.908 −0.02 1.26 0.01 0.86 0.935
z−0.661.21−0.580.810.8380.041.59−0.381.340.465 −0.62 1.55 −0.95 1.00 0.508
Nasal floorAnglel°l0.031.39−0.701.170.1470.401.430.691.080.551 0.43 1.69 −0.01 1.41 0.462
Rightx−1.070.81−1.220.950.6610.491.060.150.760.329 −0.58 0.94 −1.08 1.33 0.267
y−0.131.45−0.021.190.8220.112.450.030.770.908 −0.02 1.26 0.01 0.86 0.935
z−0.500.61−0.540.580.857−0.331.00−0.400.650.833 −0.83 1.09 −0.94 0.90 0.775
Leftx1.090.801.250.860.615−0.180.99−0.250.940.847 0.91 0.84 1.00 1.04 0.804
y−0.131.45−0.021.190.8220.112.450.030.770.908 −0.02 1.26 0.01 0.86 0.935
z−0.350.53−0.560.760.401−0.401.12−0.570.560.602 −0.75 1.41 −1.14 0.94 0.397
Antterior nasal spine (ANS)lxl0.210.44−0.040.680.2540.100.510.100.530.997 0.31 0.57 0.06 0.44 0.204
LF_ANSMiddle lxl0.050.400.010.400.783−0.130.37−0.010.420.425 −0.08 0.42 0.00 0.46 0.640
Pogonion (Pog)lxl−0.130.88−0.261.080.7250.230.800.121.070.753 0.10 0.79 −0.15 0.84 0.433
Menton (Me)lxl−0.220.89−0.431.070.5910.390.960.421.130.950 0.17 0.83 −0.01 1.04 0.620
Gonion (Go)lRight-LeftllxR-xLl−0.411.19−0.191.210.6390.321.57−0.171.190.360 −0.08 1.32 −0.36 1.04 0.544
lyR-yLl0.601.58−0.280.880.080−0.591.460.440.72 0.025*0.02 0.47 0.17 0.64 0.489
lzR-zLl0.410.750.510.850.729−0.170.80−0.201.030.932 0.24 0.69 0.32 1.05 0.822
T1, pre-expansion; T2, post-expansion; T3, 6 months after expansion. The coordinate system consists of three axes (x, y, and z) with their origin (0,0,0) registered at nasion (N). Positive values are to the left, posterior, and superior (LPS) to the N point of the subject. Negative values are to the right, anterior, and inferior (RAI) to the N point. MSE, maxillary skeletal expansion. lxl, absolute value of x. * p < 0.05, ** p < 0.01, *** p < 0.001. An independent sample t-test was performed.
Table
Table 6. Three-dimensional values (A) and changes (B) of nasal septum and nasofacial structures after MSE depending on the amount of midpalatal expansion.
Table 6. Three-dimensional values (A) and changes (B) of nasal septum and nasofacial structures after MSE depending on the amount of midpalatal expansion.
(A)
Variables T1 (n = 28)T2 (n = 28)T3 (n = 28)
MPEMPE < 3.65 mm (n = 14)MPE > 3.65 mm (n = 14) MPE < 3.65 mm (n = 14)MPE > 3.65 mm (n = 14) MPE < 3.65 mm (n = 14)MPE > 3.65 mm (n = 14)
Nasal Septumx,y,zMeanSDMeanSDp-ValueMeanSDMeanSDp-ValueMeanSDMeanSDp-Value
CoronalAngleUS(°)4.472.625.162.150.4484.712.585.442.460.4524.052.575.682.260.088
MS(°)168.648.67164.764.900.157168.178.31163.936.320.141170.978.21165.266.090.046 *
LS(°)6.806.5910.013.500.1197.316.2410.534.640.1345.276.128.555.130.136
LengthUS-LS(mm)47.253.5847.083.360.89547.703.3848.043.410.79447.353.7748.293.030.474
AxialAngleAS(°)2.672.525.802.640.004 **2.722.415.812.560.003 **2.482.565.762.480.002 **
MS(°)173.397.01169.165.490.087174.066.27168.885.090.024 *173.897.29169.065.180.054
PS(°)4.604.615.733.750.4844.154.025.773.550.2704.204.666.003.820.274
LengthAS-PS(mm)65.368.3264.116.550.66265.318.0364.676.770.82165.608.2565.655.930.985
CoronalUSlxl0.800.590.610.540.3850.710.650.660.640.8570.820.630.620.570.385
MSlxl2.071.172.981.320.0642.171.083.001.430.0931.761.143.001.470.019 *
LSlxl1.150.941.200.870.8851.210.851.220.960.9921.000.701.130.640.614
AxialAS lxl1.180.921.441.350.5601.230.691.191.010.9141.150.921.141.120.990
MSlxl1.631.073.111.460.005 **1.661.013.161.490.005 **1.581.203.161.460.004 **
PS lxl1.351.111.511.220.7211.461.001.651.390.6761.300.951.541.310.584
Lateral nasal wallAngleRight(°)23.922.6823.632.420.76825.042.7324.962.420.93124.802.4824.982.170.840
Left(°)23.932.9523.062.240.38524.722.6824.302.350.66524.892.6424.202.620.494
x,y,zRightx−16.962.01−16.231.230.262−18.062.35−17.481.220.420 −17.86 1.95 −17.55 1.23 0.618
y26.618.3827.066.190.87426.437.6827.096.520.807 27.19 8.40 26.47 5.95 0.796
z−43.805.17−42.772.380.508−44.114.92−43.192.580.544 −44.39 4.97 −43.40 2.30 0.508
x,y,zLeftx16.432.7115.561.280.29217.212.5417.071.400.860 17.22 2.51 17.07 1.55 0.848
y26.618.3827.066.190.87426.437.6827.096.520.807 27.19 8.40 26.47 5.95 0.796
z−43.835.30−42.212.720.320−44.105.19−43.172.320.548 −44.29 5.22 −43.33 3.19 0.561
Nasal floorAnglel°l1.891.152.220.990.4141.231.132.221.700.0832.131.202.401.780.645
Rightx−8.892.57−8.261.820.457−9.832.25−9.622.190.801 −9.51 2.16 −9.30 2.47 0.807
y26.618.3827.066.190.87426.437.6827.096.520.807 27.19 8.40 26.47 5.95 0.796
z−54.314.07−53.173.450.427−54.644.04−53.883.410.594 −54.87 4.21 −54.38 3.13 0.727
Leftx8.082.498.221.830.8648.832.539.811.890.254 8.90 2.80 9.31 1.96 0.652
y26.618.3827.066.190.87426.437.6827.096.520.807 27.19 8.40 26.47 5.95 0.796
z−54.494.19−52.853.810.289−54.654.16−53.613.900.502 −54.89 4.12 −54.34 3.84 0.717
Antterior nasal spine (ANS)lxl1.020.820.880.950.6941.280.920.790.580.1061.200.871.070.740.684
LF_ANSMiddle lxl0.850.910.770.780.7940.930.820.750.870.5918.513.576.523.450.144
Pogonion (Pog)lxl2.411.913.231.920.2672.541.842.712.580.842.552.143.042.310.565
Menton (Me)lxl2.442.023.502.070.1832.491.992.792.800.7472.712.303.392.610.467
Gonion (Go)lRight-LeftllxR-xLl4.122.302.922.040.1544.032.772.422.260.1044.263.002.342.060.059
lyR-yLl1.611.002.251.670.2322.261.871.921.620.611.951.132.101.460.767
lzR-zLl1.451.422.102.190.3611.851.792.632.190.3071.891.702.222.500.686
(B)
Variables T2-T1 (n = 28)T3-T2 (n = 28)T3-T1 (n = 28)
MPEMPE < 3.65 mm (n = 14)MPE > 3.65 mm (n = 14) MPE < 3.65 mm (n = 14)MPE > 3.65 mm (n = 14) MPE < 3.65 mm (n = 14)MPE > 3.65 mm (n = 14)
Nasal Septumx,y,zMeanSDMeanSDp-ValueMeanSDMeanSDp-ValueMeanSDMeanSDp-Value
CoronalAngleUS(°)0.240.690.270.980.926 −0.661.540.240.910.072 −0.41 1.90 0.52 0.75 0.100
MS(°)−0.472.64−0.832.670.722 2.804.251.333.400.321 2.33 4.01 0.50 3.16 0.190
LS(°)0.512.180.522.480.996 −2.043.00−1.983.520.960 −1.53 2.83 −1.46 3.26 0.954
LengthUS-LS(mm)0.450.970.960.820.144 −0.351.240.251.570.269 0.10 0.56 1.21 1.23 0.005 **
AxialAngleAS(°)0.051.050.011.130.937 −0.231.28−0.050.920.669 −0.19 0.58 −0.04 1.55 0.738
MS(°)0.671.22−0.271.620.095 −0.171.680.171.390.565 0.50 1.26 −0.10 2.46 0.484
PS(°)−0.451.100.040.860.202 0.051.820.241.350.764 −0.40 1.39 0.28 1.46 0.223
LengthAS-PS(mm)−0.050.590.561.240.114 0.292.080.991.520.321 0.24 2.28 1.55 1.44 0.082
CoronalUSlxl−0.090.510.050.260.354 0.110.50−0.050.250.310 0.02 0.21 0.01 0.27 0.907
MSlxl0.100.530.030.400.684 −0.411.130.000.320.214 −0.31 1.04 0.03 0.30 0.874
LSlxl0.070.630.020.670.852 −0.210.69−0.080.860.671 −0.14 0.57 −0.06 0.54 0.705
AxialAS lxl0.050.44−0.240.610.158 −0.080.49−0.050.520.874 −0.03 0.40 −0.29 0.58 0.175
MSlxl0.030.500.050.380.889 −0.090.45−0.010.300.587 −0.06 0.30 0.05 0.44 0.472
PS lxl0.110.780.140.300.880 −0.160.74−0.120.340.834 −0.05 0.24 0.03 0.37 0.504
Lateral nasal wallAngleRight(°)1.121.061.330.640.545 −0.240.900.020.690.392 0.88 0.71 1.35 0.68 0.086
Left(°)0.791.341.240.570.257 0.171.08−0.101.100.514 0.96 0.78 1.14 1.13 0.621
x,y,zRightx−1.101.03−1.250.480.638 0.191.03−0.080.470.382 −0.91 0.56 −1.32 0.59 0.067
y−0.181.470.031.160.667 0.761.90−0.621.400.038 *0.58 0.99 −0.59 0.80 0.002
z−0.310.91−0.411.020.767 −0.281.09−0.211.220.872 −0.59 0.87 −0.63 1.08 0.918
x,y,zLeftx0.780.611.510.390.001 **0.020.430.000.800.951 0.80 0.50 1.51 0.71 0.005 **
y−0.181.470.031.160.667 0.761.90−0.621.400.038 *0.58 0.99 −0.59 0.80 0.002 **
z−0.280.98−0.960.950.072 −0.190.78−0.151.950.951 −0.46 0.93 −1.11 1.54 0.188
Nasal floorAnglel°l−0.661.43−0.011.150.198 0.901.140.191.290.132 0.25 1.77 0.18 1.33 0.908
Rightx−0.940.97−1.360.740.207 0.320.980.320.900.994 −0.62 0.98 −1.04 1.32 0.350
y−0.181.470.031.160.667 0.761.90−0.621.400.038 *0.58 0.99 −0.59 0.80 0.002 **
z−0.330.65−0.710.450.078 −0.230.43−0.501.100.406 −0.56 0.53 −1.21 1.22 0.076
Leftx0.750.901.590.450.004 **0.070.52−0.501.190.118 0.82 0.91 1.09 0.96 0.447
y−0.181.470.031.160.667 0.761.90−0.621.400.038 *0.58 0.99 −0.59 0.80 0.002 **
z−0.160.69−0.760.470.012 *−0.240.40−0.731.140.142 −0.40 0.73 −1.49 1.33 0.013 *
Antterior nasal spine (ANS)lxl0.260.57−0.090.550.105 −0.080.430.280.540.058 0.180.620.190.420.972
LF_ANSMiddle lxl0.080.48−0.010.300.571 7.594.035.763.450.210 7.664.085.753.420.191
Pogonion (Pog)lxl0.130.50−0.521.210.075 0.020.660.341.140.376 0.140.74−0.190.870.288
Menton (Me)lxl0.050.52−0.701.180.037 *0.210.670.601.300.334 0.270.67−0.111.120.298
Gonion (Go)lRight-LeftllxR-xLl−0.091.26−0.501.110.376 0.231.62−0.081.160.571 0.131.26−0.581.000.111
lyR-yLl0.651.60−0.330.810.051 −0.321.620.170.670.306 0.340.42−0.150.580.017 *
lzR-zLl0.390.780.530.820.649 0.050.67−0.411.070.185 0.440.860.120.890.344
T1, pre-expansion; T2, post-expansion; T3, at least 6 months post-expansion. The coordinate system consists of three axes (x, y, and z) with their origin (0,0,0) registered at nasion (N). Positive values are to the left, posterior, and superior (LPS) to the N point of the subject. Negative values are to the right, anterior, and inferior (RAI) to the N point. MSE, maxillary skeletal expansion. lxl, absolute value of x. * p < 0.05, ** p < 0.01. An independent sample t-test was performed.
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Lee, H.-J.; Park, J.H.; Seo, H.Y.; Choi, S.-K.; Chang, N.-Y.; Kang, K.-H.; Chae, J.-M. A CBCT Evaluation of Nasal Septal Deviation and Related Nasofacial Structures after Maxillary Skeletal Expansion. Appl. Sci. 2022, 12, 9949. https://doi.org/10.3390/app12199949

AMA Style

Lee H-J, Park JH, Seo HY, Choi S-K, Chang N-Y, Kang K-H, Chae J-M. A CBCT Evaluation of Nasal Septal Deviation and Related Nasofacial Structures after Maxillary Skeletal Expansion. Applied Sciences. 2022; 12(19):9949. https://doi.org/10.3390/app12199949

Chicago/Turabian Style

Lee, Hye-Jeong, Jae Hyun Park, Hye Young Seo, Sung-Kwon Choi, Na-Young Chang, Kyung-Hwa Kang, and Jong-Moon Chae. 2022. "A CBCT Evaluation of Nasal Septal Deviation and Related Nasofacial Structures after Maxillary Skeletal Expansion" Applied Sciences 12, no. 19: 9949. https://doi.org/10.3390/app12199949

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