Prosthetics for Nasoseptal Perforation Repair: A Systematic Review

Abstract

Objectives:

Prosthetics—including buttons and other obturators serve as an option for nasoseptal perforation repair in patients who have active systemic disease, are poor surgical candidates, or wish to avoid surgery. By systematically reviewing the literature on prosthetics for nasoseptal perforation repair, the objective of the present study is to critically appraise previous studies, provide evidence-based guidelines for nasoseptal prosthetic use, and identify areas for further investigation.

Methods:

The Cochrane Controlled Trials Register, EMBASE, PubMed, and Web of Science 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. The reference lists of included articles were searched for additional studies. Each included article’s level of evidence was identified and grades of recommendation were assigned.

Results:

The search yielded 4756 abstracts for review, with 23 case series and 5 case reports meeting inclusion criteria. A total of 706 cases of prosthetic nasoseptal perforation repair were identified, with a case series median n = 20. 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.

Conclusions:

The literature provides considerable level 4 evidence for the efficacy and safety of prosthetics for nasoseptal perforation repair with success rates of 33% to 100% and minimal complications: only 1 fungal infection and 9 unspecified infections in 706 cases. The disease- and prosthetic-specific factors influencing symptom improvement and prosthetic tolerance require additional study for further elucidation.