Impact of Septal Extension Graft on Functional and Esthetic Outcomes in Patients with Severe Nasal Deviation: A Systematic Review and Meta-analysis.

Background: Severe nasal deviation is a complex deformity affecting the esthetics and functionality of the nose, creating an asymmetrical appearance due to septal misalignment. Advances in nasal anatomy and biomechanics have led to the use of grafting materials, such as septal extension grafts. However, its efficacy remains inconclusive. This study investigated the impact of septal extension grafts on the functional and esthetic outcomes in severe nasal deviation.

Methods: A literature search was conducted using PubMed, Google Scholar, MEDLINE, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to date. Studies were selected based on predefined eligibility criteria, and the Cochrane Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool was used to assess bias risk.

Results: The search yielded 1,242 records, of which 18 were included for 1763 patients. Most studies reported statistically significant improvements in Nasal Obstruction Symptom Evaluation (NOSE) scores and nasal symmetry. Improved esthetic outcomes and patient satisfaction were observed after septal extension graft procedures. Patients also experienced increased tip projection and reduced dorsal deviation, with p<0.001 in most studies. The revision rate was significantly lower (OR 0.02, 95% CI 0.00-0.09, p<0.00001). However, slight complications were observed, including tip stiffness (affecting up to 45.5% of patients) and tip deviation (11.4%).

Conclusion: Patients with severe nasal deviation consistently improved functional and esthetic outcomes, experienced favorable patient satisfaction, and achieved long-term stability. However, careful consideration is essential due to reported complications and occasional revision surgeries.

Level of evidence iii: This review includes well-designed cohort and case-control studies, which provide moderate-quality evidence on the efficacy of septal extension grafts in treating severe nasal deviation. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .