Purpose <p>Identifying nasal deviation in patients requiring orthognathic surgery is critical for developing an accurate treatment plan, particularly in the axial plane. This study aimed to evaluate the prevalence and degree of nasal and septal deviation in patients requiring orthognathic surgery, and to assess their relationship with maxillary, mandibular, and chin asymmetries, as well as dento-skeletal class.</p> Material and methods <p>A retrospective study was conducted on patients who required orthognathic surgery between July 2020 and February 2021. Exclusion criteria included congenital craniofacial anomalies, history of mandibular condylar hyperplasia, or prior rhino-septoplasty procedures.</p> Results <p>Of the 103 patients studied, 97.1% exhibited some degree of nasal deviation, and all presented with septal deviation. Nasal septum deviation correlated significantly with nasal tip deviation (<i>r</i> = 0.44, <i>p</i> &lt; 0.001) and dorsum deviation (<i>r</i> = 0.41, <i>p</i> &lt; 0.001). A combination of nasal, maxillary, mandibular, and chin deviations was present in 77.3%, 83.5%, and 88.3% of patients, respectively. Significant correlations were found between the directions of maxillary (<i>r</i> = 0.21, <i>p</i> = 0.032), mandibular (<i>r</i> = 0.25, <i>p</i> = 0.012), and chin deviations (<i>r</i> = 0.19, <i>p</i> = 0.050).</p> Conclusions <p>This study highlights that nasal and septal deviations are highly prevalent in patients requiring orthognathic surgery, and their accurate diagnosis is essential for successful orthognathic diagnosis and surgical planning. These findings support the inclusion of nasal assessments in the treatment plans for orthognathic surgery patients.</p>