Comparing Nasal Splints and Quilting Sutures in Septoplasty: A Systematic Review and Meta-analysis.

[BACKGROUND] Nasal packing post-septoplasty often leads to discomfort, breathing difficulties, and elevated infection risk. Alternative methods, such as intranasal splinting and quilting sutures, have been proposed to mitigate these issues. This study evaluates their effectiveness in reducing postoperative pain and complications.

[METHODS] A comprehensive literature search for peer-reviewed original research articles was conducted via multiple electronic databases, including MEDLINE via PubMed, Scopus, EBSCOhost, ProQuest Central, and the Cochrane Central Register of Controlled Trials (CENTRAL), from inception to December 2023. The Cochrane Collaboration's Risk of Bias 2.0 tool (RoB 2.0) was utilized to assess the risk of bias in randomized controlled trials. In addition, the Newcastle-Ottawa Scale (NOS) was used to assess the quality of the eligible observational studies. Data were then systematically extracted and thematically analyzed.

[RESULTS] Ten comparative studies for 575 patients were included in this review. The analysis showed that quilting sutures significantly reduced postoperative pain compared to nasal splints (MD -2.247, 95% CI -3.273 to -1.221,  < 0.001). There were no significant differences between the two interventions in terms of infection (RR 0.826, 95% CI 0.260 to 2.619), hematoma (RR 1.314, 95% CI 0.374 to 4.622), septal perforation (RR 0.836, 95% CI 0.255 to 2.746), synechia formation (RR 1.204, 95% CI 0.319 to 4.550), adhesion (RR 2.481, 95% CI 0.643 to 9.579), and crust formation (RR 1.533, 95% CI 0.502 to 4.683). Notably, quilting sutures were associated with a lower risk of post-nasal drip, according to one study.

[CONCLUSION] Quilting sutures are preferable for reducing postoperative pain in septoplasty patients, with both interventions showing comparable rates of postoperative complications. This suggests a potential shift towards quilting sutures for a more comfortable postoperative recovery.