A deviated septum occurs when the nasal septum, the thin wall of cartilage and bone separating the two nasal passages, is significantly displaced to one side. This misalignment can partially or fully obstruct one airway, making nasal breathing difficult. Facial asymmetry is the observable difference between the left and right sides of the face, where features do not perfectly mirror each other. This article examines the relationship between this common nasal abnormality and the development of uneven facial features.
The Link Between Septal Deviation and Facial Structure
A direct cause-and-effect relationship between a deviated septum and overall facial asymmetry in adults is uncommon. However, a severely deviated septum can contribute to facial unevenness, especially if the deviation occurs during the critical periods of facial growth in childhood and adolescence. The nasal septum is a significant growth center for the mid-face, and its asymmetrical development is associated with unevenness in surrounding skeletal structures.
This structural influence is typically an indirect, long-term consequence of functional changes. Clinical observations suggest that a significant septal deviation, which physically restricts the nose, can impact the alignment of the nasal floor and the upper jaw. This influence on the nasal and palatal regions suggests a localized effect that can set the stage for broader changes.
Myofunctional Changes Caused by Altered Breathing
The mechanism connecting a deviated septum to wider facial asymmetry is primarily related to altered breathing patterns. Chronic nasal obstruction often necessitates obligatory mouth breathing, particularly during sleep. This shift triggers a cascade of myofunctional changes—alterations in the function of the muscles of the face and mouth.
When the mouth is habitually open, the tongue’s resting posture drops low and flat instead of resting against the hard palate. The constant pressure of the tongue on the palate is necessary to guide the lateral expansion and proper growth of the maxilla, or upper jaw. Without this pressure, the maxilla can develop too narrowly, often resulting in a high, vaulted palate and dental crowding.
This compromised growth of the upper jaw then affects the alignment of the lower jaw and surrounding facial muscles, leading to malocclusion, or a misaligned bite. Over time, the unbalanced forces from the facial and chewing muscles, combined with an altered jaw position, can contribute to the visible unevenness of the mid and lower face.
Other Common Contributors to Facial Asymmetry
A deviated septum is only one potential factor in a complex condition, as most facial asymmetry is caused by unrelated issues. Genetics play a substantial role, determining the foundational structure, size, and shape of the facial bones and features. Many people have subtle, natural variations between the two sides of their face that are simply inherited traits.
Trauma, such as a past injury or fall, can lead to fractures that heal unevenly, resulting in noticeable asymmetry of the nose, cheekbones, or jaw. Issues with the temporomandibular joint (TMJ) can also cause the lower jaw to shift, leading to an uneven bite and muscle imbalance. Habits like consistently chewing on one side can cause one set of facial muscles to become more developed than the other over many years.
Evaluating and Treating Septal Deviation and Asymmetry
Diagnosing the precise cause of facial asymmetry requires a multidisciplinary approach, often involving an otolaryngologist (ENT), a dentist, and sometimes an orthodontist or craniofacial specialist. Diagnosis of a deviated septum involves a physical examination using a nasal speculum, occasionally supplemented by a CT scan to visualize the internal bony and cartilaginous structures.
Treatment for a symptomatic deviated septum is usually septoplasty, a surgical procedure to straighten the cartilage and bone to restore proper nasal breathing. If the external appearance of the nose is also distorted, septoplasty may be combined with rhinoplasty in a procedure known as septorhinoplasty. Correcting the septal deviation is the foundational step, as it addresses the root functional cause of the altered breathing pattern.
Addressing the resulting facial asymmetry is often a separate, secondary process that depends on the patient’s age and the severity of the skeletal changes. For developmental issues, this may involve orthodontics, palate expansion, or myofunctional therapy to retrain the tongue and facial muscles. In severe adult cases, orthognathic (jaw) surgery may be required to correct significant skeletal misalignment caused by long-term growth deviations.