Gravina Arron, Pai Kavya K, Shave Samantha, Eloy Jean Anderson, Fang Christina H
Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA.
Ann Otol Rhinol Laryngol. 2023 May;132(5):527-535. doi: 10.1177/00034894221098704. Epub 2022 Jun 8.
Surgical repair of nasal septal perforations (NSPs) is technically challenging. Advantages associated with endoscopic NSP repair (ENSPR) include enhanced visualization and its minimally invasive nature. Purely endoscopic techniques have successful outcomes with low morbidity. This study provides a review of clinical features, surgical techniques, and outcomes in patients who underwent ENSPR.
A systematic review was conducted using PubMed/MEDLINE, Cochrane library, and Embase databases. Manual bibliography search produced additional articles. Studies reporting purely endoscopic approaches for NSP repair were included. Patient demographics, NSP size, etiology, repair strategy, incidence of closure, and follow-up were analyzed.
A total of 329 cases from 20 studies were included. The mean age was 37.2 years (range, 12.3-51 years) and 55.0% were male. Common etiologies were iatrogenic (n = 180, 60.0%), trauma (n = 66, 22.0%), and idiopathic (n = 36, 12.0%). The mean NSP size was 17.1 mm (range, 4-23). Repair techniques included unilateral random pattern flaps (n = 205, 62.3%), interposition grafts (n = 137, 41.6%), and unilateral axial pedicled local flaps (n = 81, 24.6%). 222 patients (67.5%) underwent a 2-layered repair, while 70 (21.3%) and 37 (11.2%) patients underwent single and 3-layered repairs, respectively. Successful closure was achieved in 296 patients (90.0%). When stratified by layers of repair, 65 single-layered (92.9%), 196 2-layered (88.3%), and 34 3-layered repairs (91.9%) were successful at a mean follow-up of 16.3 months (range, 3-31 months).
ENSPR generally achieves NSP closure with high rates of success among varying types of repairs. Further studies may determine how clinical factors and surgical methods impact the likelihood of obtaining successful closure.
鼻中隔穿孔（NSP）的手术修复在技术上具有挑战性。内镜下鼻中隔穿孔修复术（ENSPR）的优点包括视野增强及其微创性。单纯内镜技术具有成功率高、发病率低的特点。本研究对接受ENSPR治疗的患者的临床特征、手术技术和结果进行了综述。
使用PubMed/MEDLINE、Cochrane图书馆和Embase数据库进行系统综述。手动文献检索补充了其他文章。纳入报告单纯内镜下NSP修复方法的研究。分析患者的人口统计学特征、NSP大小、病因、修复策略、闭合率和随访情况。
共纳入20项研究中的329例病例。平均年龄为37.2岁（范围12.3 - 51岁），男性占55.0%。常见病因包括医源性（n = 180，60.0%）、创伤（n = 66，22.0%）和特发性（n = 36，12.0%）。NSP的平均大小为17.1毫米（范围4 - 23毫米）。修复技术包括单侧随机皮瓣（n = 205，62.3%）、植入移植片（n = 137，41.6%）和单侧轴型带蒂局部皮瓣（n = 81，24.6%）。222例患者（67.5%）进行了两层修复，而70例（21.3%）和37例（11.2%）患者分别进行了单层和三层修复。296例患者（90.0%）成功闭合。按修复层数分层时，65例单层修复（92.9%）、196例两层修复（88.3%）和34例三层修复（91.9%）在平均随访16.3个月（范围3 - 31个月）时成功。
ENSPR在不同类型的修复中通常能实现较高的NSP闭合成功率。进一步的研究可能会确定临床因素和手术方法如何影响成功闭合的可能性。
