Prosthetics for nasoseptal perforations: A systematic review and meta-analysis

Objective. Prosthetics serve as an option for nasoseptal perforation treatment in patients who have active systemic disease, are poor surgical candidates, or wish to avoid surgery. Through systematic review of the literature on prosthetics for nasoseptal perforation treatment, the objective of the present study is to critically appraise previous studies, evaluate the success rate for nasoseptal prosthetics, provide evidence-based guidelines for nasoseptal prosthetic use, and identify areas for further investigation. Data Sources. Cochrane Controlled Trials Register, EMBASE, PubMed, and Web of Science. Review Methods. Data sources were queried for relevant articles published from 1965 to 2013. Articles were selected for inclusion if they presented primary data for human nasoseptal perforation treatment utilizing prosthetic materials. Each included article's level of evidence and risk of bias were identified and grades of recommendation were assigned. A quantitative meta-analysis was performed on articles with low risk of bias. Results. The search yielded 4756 abstracts for review, with 23 included case series and 5 case reports; 706 total cases of prosthetic nasoseptal perforation treatment were identified. All articles provided level 4 evidence, with an overall conclusion grade of C for improvement in nasoseptal perforation symptoms, prosthetic in situ rate, and complication rate. Meta-analysis of 6 low-risk-of-bias studies with 297 patients demonstrated an overall success rate of 65%. Conclusions. The literature provides level 4 evidence for the efficacy and safety of prosthetics for nasoseptal perforation treatment with favorable success rates and few reports of complications-only 1 fungal infection and 9 unspecified infections-in 706 cases.