Nasal septum deviation after orthognathic Le Fort I osteotomy: a systematic review and meta-analysis.

BACKGROUND

Orthognathic Le Fort I osteotomy (LF-IO) reinstates an accurate anatomical and functional interrelation between the facial skeletal structures. There are numerous reports in the literature regarding nasal ventilation after LF-IO, yet the number of studies focused on nasal septum angle/deviation is limited.

PURPOSE

This systematic review was designed to gather and analyze all of the human studies that have investigated nasal septum angle and deviation before and after LF-IO. DATA SOURCES: An electronic search was executed in Medline via PubMed, Web of Science, Scopus, and Google Scholar to identify eligible studies Only in English language up to July 10, 2025.

STUDY SELECTION

Randomized and non-randomized human clinical studies on adult patients undergoing single-piece or segmental LF-IO with no history of facial traumas and/or anomalies.

DATA EXTRACTION AND SYNTHESIS

Random-effects model analysis was used in all cases. The risk of publication bias was assessed using a funnel plot and Egger's test. All statistical analyses were executed using Comprehensive Meta-analysis software with the significance threshold of 0.05.

MAIN OUTCOMES AND MEASURES

Changes in nasal septum angle measured in degrees and through radiography and alar base width changes measured in millimeters.

RESULTS

One non-randomized clinical trial, ten retrospective and One prospective cohort studies were included; 579 patients were enrolled with a gender ratio of 217:362 (male:female) and an age range of 16 to 56 years old. Four of the included studies had high and eight had moderate qualities regarding their risk of bias. Most patients underwent LF-IO to correct Class III malocclusions. Single-piece LF-IO combined with alar base cinch suture was the most popular surgical procedure. Frontal sections in computed tomography before and 12 months after LF-IO was the most utilized evaluation method. Six studies were selected for various meta-analyses with significantly low publication bias. Releasing nasal septum during LF-IO leads to significant increases in septum angle. CONCLUSIONS AND RELEVANCE: LF-IO, especially maxillary advancement, significantly increases nasal septum angle and alar base width. A clear definition and diagnosis protocol must be established for nasal septum deviation. Future studies must focus on highlighting a fine line between significant and insignificant changes in nasal septum after LF-IO.