Abstract:
Background: Caudal septal deviation involves displacing the anterior part of the nasal septum, leading to breathing difficulties, nasal obstruction, snoring, and aesthetic concerns. This condition can be congenital, caused by trauma, or result from previous medical procedures. It affects the nasal valve area and tip, complicating surgical management. Challenges include cartilage memory and risks such as loss of nasal tip support. While various surgical techniques are available, they are only sometimes ideal. Methods: We conducted a systematic review and meta-analysis by searching Medline, SCOPUS, PubMed, and Cochrane Library databases and manually checking references until February 2024. We used a random-effects model for meta-analyses to assess functional and aesthetic outcomes and complication rates. Heterogeneity was measured using the I² statistic, and publication bias was evaluated with funnel plots and Egger's test. Results: We included forty-one articles published from 1994 to 2022, covering 3,055 cases with an average age range of 17 to 49 years. The study designs were retrospective (23), prospective (16), case report (1), and case-control (1). Surgical techniques demonstrated improvements in both functional and aesthetic outcomes. Common complications included hemorrhage/hematoma and dorsal irregularities. The most common causes were developmental, followed by traumatic causes. Severe caudal dislocations often required grafting or extracorporeal techniques, while milder cases utilized less invasive methods like laser-assisted septoplasty and suturing. The study also discussed two classification systems to understand and treat caudal septal deviations better. ComparingSurgical Outcomes: We used Patient-reported Outcome Measures (PROMs) like Nasal Obstruction Symptom Evaluation (NOSE), Visual Analogue Scale (VAS), and Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) to evaluate surgical effectiveness. Significant improvements were noted across different techniques, although variability highlighted the need for standardized protocols. VAS scores showed significant pain reduction with the suture technique, and NOSE scores indicated improvements in nasal obstruction symptoms post-surgery. Conclusions: This study provided a comprehensive analysis of surgical techniques for caudal septal dislocation, emphasizing the importance of selecting techniques based on case specifics and patient awareness. It introduced new techniques and classification systems and advocated for further research to enhance patient outcomes and understanding of caudal septal deviations.
