Timing of Nasal Splint Removal After Septoplasty and Its Effects on Postoperative Functional Outcomes and Complications: A Systematic Review and Meta-Analysis

The optimal timing for intranasal splint removal following septoplasty remains controversial. This systematic review and meta-analysis assessed how splint removal timing affects postoperative pain, nasal function, olfactory performance, and complications. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically searched PubMed, Google Scholar, and Web of Science (PROSPERO: CRD420251129055). Six studies from Turkey (2011-2024) involving 516 patients were included. Participants were stratified into early (days 1-3), intermediate (days 4-7), and late (>7 days) removal groups. Data were pooled using random-effects models. Results indicated that pain outcomes did not differ between early and intermediate removal, evidenced by a standardized mean difference (SMD) of 0.04 (p=0.80), but pain was significantly lower with late removal compared to intermediate timing (SMD 1.24, p<0.001). Nasal Obstruction Symptom Evaluation (NOSE) scores favored early (SMD -0.57, p=0.037) and intermediate (SMD -0.73, p=0.008) removal over late removal. Olfactory function, assessed using the Connecticut Chemosensory Clinical Research Center (CCCRC) odor test, was impaired with early removal compared to intermediate (SMD -0.56, p=0.039) and late removal (SMD -0.55, p=0.045). While complications showed no significant differences among groups, septal perforation risk was higher with early removal (OR 5.69, 95% CI 0.94-34.44, p=0.059), but this difference did not reach statistical significance. Notably, all included studies were conducted in Turkey, which may limit the generalizability of these findings to other populations and clinical settings. Ultimately, intermediate splint removal (days 4-7) may offer a favorable balance between pain control, functional recovery, and complication prevention following septoplasty.