Changes in Nasal Cavity Morphology Following Subcranial or Transcranial Midface Advancement

Background and Purpose: In patients with craniofacial syndromes characterized by midface hypoplasia, subcranial or transcranial midface advancement is the preferred technique to attain optimal functional and esthetic results. This procedure entails the creation of oblique osteotomies in the nasal septum and occasionally results in fractures of the turbinate. The objective of this study is to evaluate the quantitative and qualitative changes to these nasal structures after craniofacial disjunction. Methods: Patients from our center were included if they underwent subcranial or transcranial midface advancements, including LeFort II, III, or monobloc procedures, and possessed suitable pre- and postoperative CT scan data. Pre- and postoperative CT scans were evaluated based on several intranasal measurements including: degree of nasal septum deviation, morphology of the inferior turbinate, width of the piriform aperture, and nasal airway volume, and qualitative airway analysis. Results: Eight patients were included, with a mean age at surgery of 14.2 ± 5.3 years. Following surgery, the sella-nasion (S-N) distance increased by 9.6 mm (95% CI: 5.4, 13.9). No significant postoperative changes were found in nasal septum deviation, piriform aperture width, or nasal cavity airway volume. Of the inferior turbinate dimensions measured, only the breadth, measured at 50% the length of the turbinate, decreased significantly following surgery by 0.72 mm (95% CI: 0.02, 1.41). Correlation analysis revealed a significant relationship between the increase in S-N distance and nasal septum deviation area. Qualitative analysis showed that all 8 patients developed synechiae between the nasal septum and turbinate, and all patients developed septal perforation/resorption postoperatively. Conclusions: Craniofacial disjunction procedures may lead to notable septal and intranasal deformities which need to be considered when planning for surgery. All patients had some degree of septal perforation, resorption and nasal synechia post operatively.