Extracorporeal Septoplasty for Severe Nasal Septal Deviation: A Systematic Review

Objective: Extracorporeal septoplasty (ECS) is a surgical technique used to address severe nasal septal deviations, especially in patients in whom in situ septoplasty (ISS) is insufficient. This systematic review assesses the efficacy, safety, and clinical outcomes of ECS techniques, including conventional and modified ECS methods. Data sources: PRISMA-compliant systematic search of PubMed, Scopus, Web of Science, and Embase. Methods: Studies on ECS techniques were included. Eligibility criteria were established using the PICOTS framework. Study quality was assessed using the Cochrane Risk of Bias 2 tool and the Newcastle-Ottawa Scale. Functional and aesthetic improvements were primary outcomes, while complication rates represented secondary outcomes. Results: Twenty-two studies (retrospective, prospective, and RCTs) met the inclusion criteria. ECS was associated with significant functional improvement, as assessed by nasal obstruction scores measured by NOSE scores, acoustic rhinometry, and rhinomanometry. Aesthetic results were also satisfactory, with a significant improvement in the nasofrontal angle, nasolabial angle, and the tip projection index, as well as good patients' satisfaction. Complications were rare, with few cases of septal perforation, graft resorption, or residual nasal obstructive symptoms. Evidence strength was limited considering the majority of included studies were retrospective, with inherent bias risks, small sample sizes, and inconsistent follow-up durations. Conclusions: ECS may be a successful and safe method for severe septal deviation correction, providing functional and aesthetic results with a low complication rate. More high-quality, multicenter RCTs with long-term follow-up will be required for a standardization of surgical protocols and outcome measures. Level of evidence: 2.