Postoperative management in the prevention of complications after septoplasty: a systematic review.

OBJECTIVES/HYPOTHESIS The purpose of this article is to assess the relative rates of septal hematomas, synechiae, and septal perforations associated with methods commonly used to manage the nasal septum after septoplasty. As a secondary objective, we assessed the relative contribution of each method of septal management with respect to pain and patient discomfort. STUDY DESIGN Systematic review. METHODS A systematic literature search was performed for all relevant English randomized controlled, cohort, or case-control trials. Inclusion criteria included any study that assessed postoperative septal hematoma, perforation, or synechiae formation and reported on these outcomes regardless of method of septoplasty. Two authors independently extracted study information and analyzed all included articles for bias. RESULTS A total of 279 studies were identified, with 17 meeting the inclusion criteria. The majority of the studies had a high risk of bias that prevented the performance of a meta-analysis. Eight studies provided data on postoperative pain associated with different techniques, and quilting sutures were found to be significantly less painful than both nasal packing and septal splints. CONCLUSIONS Due to the low level of evidence and the high bias of the studies, the results of this systematic review fail to demonstrate a clear benefit among any of the postseptoplasty treatment techniques. However, the results do demonstrate that septal sutures are associated with less postoperative pain versus the other methods of septal management in this review.