High Nasal Septal Deviation and Anatomical Variations in Esthetic Rhinoplasty Patients

This retrospective study aims to evaluate paranasal computed tomography (CT) scans that were previously obtained as part of routine preoperative assessment in patients who underwent rhinoplasty for aesthetic purposes, focusing on the prevalence of sinonasal anatomic variations and high septal deviations in cases without nasal axis deformity. The study included 274 patients who underwent rhinoplasty for aesthetic reasons. Preoperative CT images of the patients were evaluated in axial slices with a thickness of 0.625 mm, along with sagittal and coronal reformats using multiplanar reconstruction. High septal deviation, as well as anatomic variations in the turbinates and sinuses, were assessed and recorded across all sections. In paranasal CT sections, measurements using the Keystone area as a reference revealed that the distance from the septum to the right lateral nasal bone was 7.4±1.9 mm, the distance to the left lateral nasal bone was 7.6±2.05 mm, and the distance to the midline was 1.13±1.02 mm. High septal deviation was detected in 47.8% (n=131) of the patients. A right middle concha bullosa was found to significantly affect the distance between the septum and the right lateral nasal bone (P<0.001). High septal deviation was frequently observed even in patients without clinically significant nasal axis deformity. The presence of right middle concha bullosa significantly influenced septal alignment, particularly affecting the distance to the right lateral nasal bone. These findings highlight the importance of detailed preoperative radiologic assessment, even in aesthetic rhinoplasty candidates without obvious septal pathology.