Septoplasty versus septoplasty with turbinate reduction for nasal obstruction due to deviated nasal septum: a systematic review and meta-analysis

Abstract

Introduction: Compensatory inferior turbinate hypertrophy is a common accompanying manifestation in patients with nasal obstruction due to deviated nasal septum (DNS). The grounds for inferior turbinate reduction (ITR) in this population are still not well established. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of septoplasty with ITR versus septoplasty alone. Methods: Computerised search in Medline, Embase, and CENTRAL was performed. Eligible for inclusion were randomised controlled trials (RCTs) comparing septoplasty to septoplasty with unilateral, contralateral, ITR in adults with DNS. Primary outcomes were health-related quality of life and nasal patency. The secondary outcome was the occurrence of adverse events. Standardised mean differences (SMD) and odds ratios (OR) with 95% confidence intervals were calculated. Results: Twelve RCTs that enrolled 775 participants were found eligible. Data were reported at follow-up periods ranging from 1 month to 48 months. The pooled effect estimate showed a statistically significant improvement with unilateral, contralateral, ITR in Nasal Obstruction Symptom Evaluation scale (NOSE) scores. The rate of adverse events was significantly higher with ITR. Conclusions: Unilateral reduction of the hypertrophied contralateral inferior turbinate during septoplasty resulted in better subjective relief of nasal obstruction in adults with DNS than septoplasty alone. However, caution is warranted since only few well-designed RCTs were identified.

Efficacy of Septoplasty in Patients with Nasal Obstruction: A Systematic Review and Meta‐analysis

“…Third, a wide range of surgical techniques are employed in the correction of nasal septal deviation and turbinates' hypertrophy, leading to a potential confounding bias. Regarding the impact of turbinate surgery on the NOSE score in the current literature, two previous systematic reviews showed a potential benefit of performing turbinoplasty in conjunction with septoplasty 6,60 . In our study, we performed a subgroup analysis distinguishing patients who underwent septoplasty with or without inferior turbinate surgery.…”

“…Regarding the impact of turbinate surgery on the NOSE score in the current literature, two previous systematic reviews showed a potential benefit of performing turbinoplasty in conjunction with septoplasty. 6,60 In our study, we performed a subgroup analysis distinguishing patients who underwent septoplasty with or without inferior turbinate surgery. Although the sample size of this analysis is relatively high, no significant difference was measured between subgroups.…”

Oromaxillofacial Surgery: Both a Treatment and a Possible Cause of Obstructive Sleep Apnea—A Narrative Review

“…Disregarding the type of nasal surgery, complications are largely the same, such as bleeding, postoperative pain and discomfort, nasal septal perforation, empty nose syndrome, chronic nasal dryness, change in the aesthetic appearance of the nose, etc. [ 60 , 61 ].…”

Long‐Term Outcomes of Septoplasty With or Without Turbinoplasty: A Systematic Review

“…63,64 A meta-analysis by Bin Lajdam et al found no significant difference in outcomes between turbinectomy, radiofrequency ablation, and "conventional turbinoplasty" techniques. 63 A systematic review by Zhang et al found that radiofrequency ablation, electrocautery, laser ablation, and submucosal resection are all effective in treating inferior turbinate hypertrophy, but did not quantitatively compare them. 65 Finally, poor psychiatric health, specifically anxiety, depression, and low self-esteem, may be associated with poorer self-perception of nasal function after surgery.…”

“…Third, septoplasty and turbinoplasty surgical techniques varied greatly between studies, which existing literature suggests can have a significant impact on outcomes. 27,58,63 We attempted to mitigate this by excluding unusually extensive techniques like marionette septoplasty and extracorporeal septoplasty to better reflect standard septoplasties that most patients receive. Fourth, even though the average MCMS of the included studies is considered "fair", nearly half were considered of "poor methodology."…”