Journal archive · Septum, valve and airway · Complications and management · Anatomy and nasal analysis · 2026
Surgical repair of large nasal septal perforation: a systematic review and meta-analysis
Cheung MH, Kim CH, Nguyen SA, Close M, Snyder V, Hwang MS.
In the archive as a landmark paper: the core sweep runs 2011–2026, and this one is here because the history of rhinoplasty rests on it · cited on septal perforation.
Abstract
Purpose: Large nasal septal perforations (NSP) pose significant surgical challenges due to limited tissue availability, increased mucosal tension, and reduced vascularity. This systematic review and meta-analysis (SRMA) evaluates closure outcomes across surgical techniques for large NSP (≥ 20 mm) and answer in patients with large nasal septal perforations, how do different surgical approaches compare in terms of successful closure and failures?
Methods: A SRMA were performed on studies employing surgical repair of large NSP (≥ 20 mm). Meta-analyses of continuous measures and proportions and comparison of weighted proportion were performed for demographic and outcomes.
Results: Thirty-eight studies comprising 408 patients with large NSP were included. The mean perforation dimensions were 22.5 mm (length), 21.3 mm (width), and 24.4 mm (diameter). Common etiologies were iatrogenic (61.2%), idiopathic (36.5%), trauma (31.4%), and drug use (28.4%). Symptoms included nasal obstruction (62.0%), crusting (49.9%), and epistaxis (45.7%). Overall surgical closure rate was 84.4% (95% CI, 80.7-87.6). By technique, success rates were 88.2% for mucosal advancement, 86.6% for interpositional grafts, 72.7% for graft-flap combinations, and 91.8% for other approaches (pedicled/composite flaps, implants). Failures with mucosal advancement were predominantly reperforations, whereas interpositional and combination repairs more often failed due to inability to achieve initial closure.
Conclusions: Surgical repair of large NSP achieves high success rates, though outcomes vary by technique. Mucosal advancement and interpositional grafts demonstrate comparable effectiveness, while graft-flap combinations perform less reliably. Larger defects remain the strongest predictor of failure, underscoring the importance of tailored surgical planning and careful technique selection.
Abstract as indexed by PubMed; the article is open access (PubMed Central).
Citation
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What the rhinoplasty literature says on this paper's topics, cited line by line to PubMed.
Septum, valve and airway
Every rhinoplasty is a breathing operation whether it intends to be or not: the septum holds the nose up as well as dividing it, and the narrowest part of the whole airway is the internal valve the surgeon is standing over.
Complications and management
Serious complications after rhinoplasty are rare: infection runs under 1% in the two largest single-surgeon series, pooled rib harvests record no pneumothorax, and the bleeding series record no thromboembolism.
Anatomy and nasal analysis
Before any technique is chosen, the nose has to be read: the bone measured, the cartilage counted, the skin assessed, and the result the patient wants agreed on a photograph that is not yet true.
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