Different surgical treatments for nasal septal perforation and their outcomes

Objective: To critically evaluate the literature on surgical treatment options for nasal septal perforations and to analyse the outcomes of these treatment options. Design: A systematic review of studies of nasal septal perforation closure using surgical intervention, published from January 1975 to March 2006. Data sources: Forty-nine papers were identified from electronic databases (all Evidence Based Medicine reviews (Cochrane Database of Systematic Reviews, American College of Physicians Journal Club, Database of Abstracts of Reviews of Effectiveness and Cochrane Controlled Trials Register), EMBASE, Ovid (Medline) and British Medical Journal publications) and from a hand search of the reference lists of retrieved papers. Textbooks pertinent to the subject were referred to for background reading. Twenty-three studies met the inclusion criteria. Main outcome measure: Effectiveness of the surgical intervention to completely close the perforation. Results: Five studies examined the sole use of intranasal mucosal flaps to close the perforation, i.e. inferior turbinate flaps, quadrangular cartilage flap and mucoperiosteal flap. Eighteen studies reported the use of a combination of intranasal mucosal flap and interposition graft. Graft materials included temporalis fascia, mastoid periosteum, nasal septal material, acellular human dermal graft, conchal cartilage and porcine small intestine mucosa. Studies utilising interposition grafts generally produced higher closure rates. The surgical approaches documented include closed endonasal, unilateral hemitransfixion, external rhinoplasty and midfacial degloving techniques. A range of surgical treatment methods was reported in the literature, but some papers were excluded from this review as they did not meet the inclusion criteria. It was difficult to infer the true effectiveness of each study as the subject numbers were small, patient selection criteria were often unspecified and the follow-up period was brief. However, factors leading to an increased chance of success were identified. Conclusion: The review found an extensive range of surgical treatment techniques, but reported results were rarely statistically significant. It is difficult to be categorical about the effectiveness of a surgical treatment method; nonetheless, each technique has its own advantages and drawbacks.