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Original Investigation
Jul/Aug 2018

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

Author Affiliations
  • 1Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head & Neck Surgery, Stanford University School of Medicine, Stanford, California
  • 2Department of Physical and Rehabilitation Medicine, Turku University Hospital and University of Turku, Turku, Finland
  • 3Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Université de Montréal, Montréal, Québec, Canada
JAMA Facial Plast Surg. 2018;20(4):307-313. doi:10.1001/jamafacial.2018.0036
Key Points

Question  Is repair of the lateral nasal wall effective in adults with nasal airway obstruction?

Finding  In this systematic review and meta-analysis of 10 studies, which included a sample of 324 participants, the pooled effect size of functional rhinoplasty on the Nasal Obstruction Symptom Evaluation scale supported the effectiveness of functional rhinoplasty for nasal airway obstruction.

Meaning  Functional rhinoplasty may be an effective treatment for nasal airway obstruction caused by lateral nasal wall insufficiency.


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  Data were 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 I2 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.

Level of Evidence  NA.