A deviated septum (DS) is a structural condition where the wall of cartilage and bone separating the nasal passages is significantly off-center. Facial asymmetry (FA) refers to a noticeable lack of correspondence between facial features on the right and left sides. While some natural facial unevenness exists, a common concern is whether DS can physically alter the face over time, leading to more pronounced FA. This article explores the link between chronic nasal obstruction caused by a deviated septum and potential physical changes in the facial skeleton.
Defining the Deviated Septum
The nasal septum is a central structure composed of cartilage and bone that divides the nasal cavity into two equal chambers. A deviation occurs when this partition is not straight, often shifting far to one side. This displacement can result from developmental issues present from birth or trauma sustained during the birthing process.
Physical trauma, such as an impact to the nose during sports or accidents, is another frequent cause. The primary consequence of this misalignment is chronic unilateral nasal obstruction, meaning one side is partially or fully blocked. This can lead to persistent symptoms such as difficulty breathing, chronic congestion, frequent nosebleeds, and disrupted sleep.
The Mechanism Linking Nasal Obstruction to Facial Change
The connection between a deviated septum and facial asymmetry involves physiological compensations, particularly during craniofacial growth. When a severe deviation causes chronic obstruction, the body shifts to a mouth-breathing pattern to satisfy oxygen demand. This change in breathing is the primary factor that alters the balance of forces shaping the growing face.
Chronic mouth breathing forces the tongue to rest low on the floor of the mouth instead of against the hard palate (the roof of the mouth). The tongue’s natural upward pressure stimulates the lateral and forward growth of the maxilla (the upper jawbone). Without this pressure, the maxilla develops too narrowly and grows downward and backward.
This altered growth pattern can lead to a longer, narrow facial structure, often termed “long face syndrome.” It also contributes to dental malocclusions like crowded teeth and crossbites. Unequal forces on the maxilla and mandible from compensatory muscle use, such as asymmetrical chewing or head posture, may further contribute to measurable asymmetry over time. The septal deviation itself can also directly affect surrounding structures, showing localized asymmetry in the palatal and nasal regions.
Diagnosis and Treatment Pathways
Diagnosis of a deviated septum and associated facial changes begins with a physical examination. A specialist uses a bright light and possibly a nasal speculum to view the internal structure. Nasal endoscopy provides a more detailed view of the septum and nasal cavity. For a comprehensive assessment, especially when facial growth or asymmetry is a concern, a Computed Tomography (CT) scan may be utilized to visualize the bony and cartilaginous structures.
The definitive treatment for a symptomatic deviated septum is septoplasty, a surgical procedure that straightens the septal wall and restores unobstructed nasal airflow. Septoplasty removes or reposition the deviated portions of bone and cartilage, addressing the root cause of the obstruction. If the external appearance of the nose is affected, septoplasty may be combined with rhinoplasty to reshape the external structure.
For existing facial asymmetry resulting from long-term altered growth, management requires a multidisciplinary approach depending on the patient’s age and the severity of skeletal changes. Treatments include orthodontic interventions to widen the dental arches and correct the bite, or, in severe adult cases, orthognathic surgery to reposition the jawbones. Correcting the underlying septal deviation is a foundational step, as normalizing the breathing pattern is crucial for preventing the progression of growth-related asymmetry, particularly in growing individuals.