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Facial Plastic and Reconstructive Surgery

Early Septoplasty vs Closed Reduction for Acute Nasoseptal Fractures: Meta-analysis

Tuesday, October 3, 2023
1:42 PM - 1:48 PM East Coast USA Time
Location: 205ABC

    Presenting Author(s)

  • EW

    Elizabeth Walker Wadsworth, MD

    Resident Physician
    Medical University of South Carolina
    Charleston, SC, United States

    • Co-Author(s)

  • Kelsey A. Duckett, BS

    Medical student, Clinical Research Fellow
    Medical University of South Carolina
    Charleston, SC, United States

    • Senior Author(s)

  • Krishna G. Patel, MD, PhD

    Professor, Director of Facial Plastic and Reconstructive Surgery
    Medical University of South Carolina
    Charleston, SC, United States

    • Co-Author(s)

  • SN

    Shaun A. Nguyen, MD, FAPCR

    Professor- Director of Clinical Research
    Medical University of South Carolina
    Charleston, SC, United States

Disclosure(s):
Elizabeth Walker Wadsworth, MD: No relevant relationships to disclose.
Kelsey A. Duckett, BS: No relevant relationships to disclose.
Introduction: Accurate management of acute nasoseptal fractures can mitigate cosmetic and functional complications. There is a lack of consensus on the ideal approach to management of acute nasoseptal fractures, which are often addressed with close nasal reduction (CNR) only and sometimes addressed using open approach with septoplasty. We aimed to systematically assess and compare outcomes of CNR versus open approaches in the treatment of acute nasoseptal fractures.

Methods: Primary studies were identified by systematic review of PubMed, Scopus, and CINAHL for articles published through July 2022. Studies were included if adult patients with acute nasoseptal fractures were treated with either CNR or open approach within 2 weeks of injury. Open approach was defined as any procedure with septal mucosal incision, including open reduction, submucous resection of septal cartilage, and septoplasty. Meta-analysis was performed to examine pooled frequency of complications including obstruction, cosmetic deformity, and need for revision surgery.

Results: Of 1,628 unique abstracts screened, 77 full-text studies were assessed and 12 were included (42% retrospective, 50% prospective, 1 RCT). Data included 1,071 patients; 682 with CNR and 418 open approach. Patient mean age was 33.4 years. Meta-analysis detected statistically significant differences between approaches. Patients who underwent CNR only were more likely to experience persistent obstruction compared to patients who underwent open approach (24.1% [95% CI=6.2-48.9] versus 5.9% [95% CI=3.5-9.5], p< 0.0001). Patients who underwent CNR were more likely to report poor cosmetic outcomes (22.3% [95%CI=10.2-37.6] vs 12.5% [95%CI=5.7-21.5], p=0.003) and require revision surgery within 3 years (28.8% [95%CI=12.7-48.3] vs 5.7% [95%CI=3.3-9.1], p< 0.0001).

Conclusions: Patients with nasoseptal fracture who underwent open septoplasty in the acute period were less likely to experience complications, including persistent obstruction, cosmetic deformity, and need for revision surgery. Prospective trials are needed to confirm results of this meta-analysis.