A contemporary review of “realistic” success rates after surgical closure of nasal septal perforations
Section snippets
Objective
Patients with nasal septal perforations (SP) suffer from various complaints such as pain, nasal obstruction, nasal dryness, severe crusting, recurrent epistaxis and whistling. These symptoms are caused by changes in air flow and air conditioning due to cross flow of air and loss of mucosa in the region of the perforation as demonstrated in numerical simulations applying computational fluid dynamics (CFD) [1] (Fig. 1, Fig. 2 (own illustrations)).
Unfortunately, previous septal surgery is still
Methods
We performed a narrative review on closure rates of SPs in order to compare the presented results and analyze data in terms of the limitations and weaknesses of the respective studies. The performance of follow-up was of particular interest. We used PubMed (https://pubmed.ncbi.nlm.nih.gov/?otool=ideubmlib) as database for search. “Septal perforation closure” were applied as search term. The search was conducted in January 2020 and search results up to 1990 were included. We discussed
Results
The complete and permanent surgical closure of SPs is a permanent challenge for rhinosurgeons. Therefore, various surgical procedures had been developed, and a relevant number of studies on the surgical success rates had been published.
Table 1 shows an exemplary, alphabetical overview of literature on surgical methods and their success rates.
Permanent surgical closure of SPs remains a challenging procedure and is difficult to achieve.
On the one hand, the great variety of different surgical
Discussion
Since the middle of the 20th century, numerous surgical methods for closing SPs have been published in literature. The large number of publications on surgical procedures, grafts, incisions and approaches indicate that surgery on SPs remains challenging and difficult.
The one surgical procedure as universal solution does not exist. All published techniques have advantages and disadvantages in their implementation and show varying success rates (30% and 100%) [8,12,14,17,26,29,[31], [32], [33],
Conclusion
In our opinion, the surgical closure of septal perforations is still one of the most complex and challenging rhinosurgical interventions. Closure rates > 90% as described in literature appear to be relatively high. The published success rates of Delaney and Kridel [40], based on an anonymously answered survey, range from 31 to 84%, depending on size of the perforation. These numbers seem to be more realistic. Short follow-up times and retrospective study designs seem to favor higher success
Disclosure statement
All authors declare no financial support or relationship that may pose a conflict of interest.
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Joerg Lindemann and Eva Goldberg-Bockhorn equally contributed to this manuscript.