Repair of the Lateral Nasal Wall in Nasal Airway Obstruction A Systematic Review and Meta-analysis

IMPORTANCE While functional rhinoplasty has been broadly studied, to our knowledge no systematic review and meta-analysis of lateral wall repair has been done previously. OBJECTIVE To evaluate the effectiveness of repair of the lateral nasal wall in adult patients with nasal airway obstruction. DATA SOURCES Medline, Embase, Cinahl, Central, Scopus, and Web of Science databases and reference lists were searched for clinical and observational studies. STUDY SELECTION The selection criteria were defined according to the PICO (population, intervention, comparison, and outcome) framework. The relevant studies were selected by 2 independent reviewers based on the studies' abstracts and full texts. DATA EXTRACTION AND SYNTHESIS Datawere extracted using standardized lists chosen by the authors according to Cochrane Collaboration guidelines. The effect sizes were first calculated for each study and then pooled together using random effects synthesis. Heterogeneity was assessed using the I-2 statistic, and publication bias was evaluated by the Egger test. MAIN OUTCOMES AND MEASURES The results were reported as pooled row mean differences in changes from preoperative to postoperative Nasal Obstruction Symptom Evaluation scores at different times of follow-up (<= 3 months, > 3 to 6 months, and > 6 months). RESULTS Of 1522 initial records, 10 studies were considered relevant-all of them observational. The pooled study sample included 324 participants. When combining all the repeated measures together, the pooled effect size for functional rhinoplasty was -47.7 (95% CI, -53.4 to 42.1) points on the Nasal Obstruction Symptom Evaluation scale with high heterogeneity of 72%. The pooled effect size outcomes were similar in short-(-45.0 points [95% CI, -47.8 to -42.2 points]), mid-(-48.4 points [95% CI, -52.5 to -44.4 points]), and long-term (-49.0 points [95% CI, -62.1 to -35.8 points]) follow-ups. CONCLUSIONS AND RELEVANCE The pooled effect size of 10 observational studies supported the effectiveness of functional rhinoplasty for the treatment of nasal airway obstruction caused by lateral nasal wall insufficiency. To improve the level of evidence, randomized clinical trials are needed.