Current Practices and Evidence in Caudal Septoplasty: A National Survey and Systematic Review

Abstract Background Caudal septal deviation is a challenging condition that affects nasal function and aesthetics. Objectives The aim of the study was to evaluate surgical practices for caudal septoplasty among otolaryngologists in Saudi Arabia and compare them with international approaches. Methods A cross-sectional electronic survey was distributed to otolaryngologists across academic, governmental, and private healthcare institutions in Saudi Arabia. A parallel systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines using PubMed, Web of Science, and Scopus. Eligible studies published between 1954 and 2024 described techniques addressing caudal septal deviation with reported outcomes. The study protocol was prospectively registered before the study's start in PROSPERO (CRD42024621207). Results Sixty otolaryngologists completed the survey. The most commonly used techniques were swinging door (76.6%), cartilage reshaping (51.7%), and suturing (48.3%). Only 16.7% had facial plastic surgery training. In the systematic review, 559 records were identified with 53 studies meeting the inclusion criteria involving 3564 patients, splinting or grafting (47.2%), and cartilage reshaping (30.2%) predominated. Patient-reported outcome measures (PROMs) were used in 66% of studies, primarily the Nasal Obstruction Symptom Evaluation scale, with scores improving from 70.2 to 16.1 postoperatively. Conclusions Otolaryngologists in Saudi Arabia predominantly employ conservative caudal septoplasty techniques, with limited adoption of extracorporeal approaches and PROMs. These findings contrast with broader international practices and highlight the need for enhanced subspecialty training and standardized outcome evaluations. Level of Evidence: 5 (Therapeutic)