European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery · 2025
Surgical repair of large nasal septal perforation: a systematic review and meta-analysis.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Cheung Matthew H, Kim Cory Hyun-Su, Nguyen Shaun A, Close Michaela, Snyder Vusala, Hwang Michelle S
Аннотация
PURPOSE: Large nasal septal perforations (NSP) pose significant surgical challenges due to limited tissue availability, increased mucosal tension, and reduced vascularity. This systematic review and meta-analysis (SRMA) evaluates closure outcomes across surgical techniques for large NSP (≥ 20 mm) and answer in patients with large nasal septal perforations, how do different surgical approaches compare in terms of successful closure and failures?
METHODS: A SRMA were performed on studies employing surgical repair of large NSP (≥ 20 mm). Meta-analyses of continuous measures and proportions and comparison of weighted proportion were performed for demographic and outcomes.
RESULTS: Thirty-eight studies comprising 408 patients with large NSP were included. The mean perforation dimensions were 22.5 mm (length), 21.3 mm (width), and 24.4 mm (diameter). Common etiologies were iatrogenic (61.2%), idiopathic (36.5%), trauma (31.4%), and drug use (28.4%). Symptoms included nasal obstruction (62.0%), crusting (49.9%), and epistaxis (45.7%). Overall surgical closure rate was 84.4% (95% CI, 80.7-87.6). By technique, success rates were 88.2% for mucosal advancement, 86.6% for interpositional grafts, 72.7% for graft-flap combinations, and 91.8% for other approaches (pedicled/composite flaps, implants). Failures with mucosal advancement were predominantly reperforations, whereas interpositional and combination repairs more often failed due to inability to achieve initial closure.
CONCLUSIONS: Surgical repair of large NSP achieves high success rates, though outcomes vary by technique. Mucosal advancement and interpositional grafts demonstrate comparable effectiveness, while graft-flap combinations perform less reliably. Larger defects remain the strongest predictor of failure, underscoring the importance of tailored surgical planning and careful technique selection.
METHODS: A SRMA were performed on studies employing surgical repair of large NSP (≥ 20 mm). Meta-analyses of continuous measures and proportions and comparison of weighted proportion were performed for demographic and outcomes.
RESULTS: Thirty-eight studies comprising 408 patients with large NSP were included. The mean perforation dimensions were 22.5 mm (length), 21.3 mm (width), and 24.4 mm (diameter). Common etiologies were iatrogenic (61.2%), idiopathic (36.5%), trauma (31.4%), and drug use (28.4%). Symptoms included nasal obstruction (62.0%), crusting (49.9%), and epistaxis (45.7%). Overall surgical closure rate was 84.4% (95% CI, 80.7-87.6). By technique, success rates were 88.2% for mucosal advancement, 86.6% for interpositional grafts, 72.7% for graft-flap combinations, and 91.8% for other approaches (pedicled/composite flaps, implants). Failures with mucosal advancement were predominantly reperforations, whereas interpositional and combination repairs more often failed due to inability to achieve initial closure.
CONCLUSIONS: Surgical repair of large NSP achieves high success rates, though outcomes vary by technique. Mucosal advancement and interpositional grafts demonstrate comparable effectiveness, while graft-flap combinations perform less reliably. Larger defects remain the strongest predictor of failure, underscoring the importance of tailored surgical planning and careful technique selection.