SRS210 - Endoscopic nasal septal perforation repair: a systematic review and meta-analysis of contemporary techniques and outcomes

Abstract Background Endoscopic repair of nasal septal perforations remains challenging, with multiple techniques available. This systematic review evaluated outcomes of endoscopic repair approaches. Methods Thirty studies comprising 574 patients were analyzed. The primary outcome was complete closure; secondary outcomes included complications and technique-specific success. A random-effects model estimated pooled success rates. Results Most studies were case series (86.7%). Across 574 patients, mean age was 37.7 ± 10.0 years, with 54.9% male. Mean perforation size was 1.52 ± 0.48 cm (range, 0.6–3.0 cm). Reported etiologies included postsurgical (46.2%), iatrogenic (15.7%), idiopathic (14.9%), and traumatic (9.4%). Surgical techniques (n = 572) were anterior ethmoidal artery (AEA) flap variants (32.5%), other/specialized methods (30.8%), bilateral mucosal (19.4), bipedicled flaps (2.8%), and cartilage/graft-based approaches (14.5%). Follow-up ranged from 4 weeks to 22 years. Complete closure was achieved in 538/556 patients (97%). Meta-analysis demonstrated a pooled success rate of 95.1% (95% c.i.: 91.5–98.0%) with moderate heterogeneity (I² = 35.3%). Subgroup analysis showed success rates of 96.5% for AEA flap variants, 95.0% for other/specialized methods, 91.7% for bilateral mucosal/bipedicled flaps, and 88.5% for cartilage/graft-based techniques. Complications were reported in 89/556 patients (16.0%), most commonly nasal crusting/discharge (8.6%), flap-related problems (3.8%), and epistaxis (1.3%). Conclusions Endoscopic septal perforation repair demonstrates high closure rates exceeding 95%. AEA flap variants yield the highest success, while complications are generally minor and manageable. Current evidence supports endoscopic approaches as highly effective for septal perforation management.