Surgical repair of nasal septal perforations: A systematic review and meta- analysis.

OBJECTIVE: A wide variety of techniques for the surgical repair of nasal septal perforations (NSP) have been described. Surgical management of NSPs can be broadly divided into open versus endonasal approaches, with additional variables involving unilateral or bilateral flaps, use of grafts, and placement of splints. The objective of this study was to compare surgical approaches and their outcomes.

DATA SOURCES: PubMed, EMBASE, and CINAHL Plus databases were examined for patients undergoing NSP repair.

REVIEW METHODS: English-language studies reporting surgical management of patients with the primary diagnosis of NSP were included. Outcome measures of interest included perforation size, surgical approach characteristics, and success rate defined as complete closure assessed by surgeon postoperatively. The quality of articles was assessed with the MINORS criteria (methodological index for nonrandomized studies). A random-effects model was used to calculate pooled proportions for the different outcomes.

RESULTS: The electronic database search yielded 1076 abstracts for review. 64 articles met the inclusion criteria, with 1591 patients: 1127 (71%) underwent an endonasal approach and 464 (29%) an open approach. The median (range) MINORS score was 10 (5-12) out of 16 points. Overall, 91% of patients had total closure (95% CI = 0.89 to 0.93, p< 0.01), with moderate heterogeneity between studies (I 2 = 42.03%). There was no difference in closure success between open and endonasal approaches. Use of bilateral vs unilateral flaps, interposition grafts, and intranasal splints and packing were not associated with differences in outcomes.

CONCLUSIONS: Nasal septal perforation surgical repair success rates are comparable regardless of technique. This article is protected by copyright. All rights reserved.