title: Open versus endoscopic septoplasty techniques: A systematic review and meta-analysis.
abstract: BACKGROUND
  Septal deviation is a condition of high prevalence, which ranges from 22% in newborns to 90% in adults. Surgical intervention is frequently considered in the management of patients with symptoms. Although many surgeons prefer either the endoscopic or the open approach to septoplasty, there is an ongoing debate regarding comparative outcomes between the two approaches.
  
  
  OBJECTIVE
  The purpose of this study was to systematically review the literature and provide pooled summary estimates to evaluate the efficacy and safety of open versus endoscopic septoplasty techniques.
  
  
  METHODS
  This study was registered with PROSPERO (CRD42014010730). MEDLINE, EMBASE, Google Scholar, CINAHL, Web of Science, and The Cochrane Central Registry for Randomized Trials were searched for relevant studies by using the following keywords in varying combinations: "nasal septum," "nasal obstruction," "nasal cartilages," "nose," "nose diseases," "surgery," "nasal/septal deviation," and "septoplasty." All the studies that compared open versus endoscopic septoplasty techniques for the management of symptomatic septal deviation were considered. Two reviewers independently extracted data by using a preestablished extraction form and performed quality assessment by using the Jadad and Newcastle Ottawa Scales. Weighted pooled estimates were calculated and reported, along with relative risks and 95% confidence intervals.
  
  
  RESULTS
  Fourteen studies met our inclusion criteria. When comparing open versus endoscopic septoplasty techniques, there was significant improvement in postoperative symptoms (i.e., nasal obstruction, headaches) (p < 0.05) in the endoscopic septoplasty group. There also were significantly fewer complications associated with the endoscopic septoplasty technique (p < 0.05). Based on the quality assessment, included studies were deemed at a moderate-to-high risk of bias.
  
  
  CONCLUSIONS
  Our analysis indicated that endoscopic septoplasty may have some advantages over open septoplasty. However, our findings should be taken with caution given the poor quality of included studies.
authors.affiliation: Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Chris J
authors.initials: CJ
authors.lastname: Hong
authors.forename: Eric
authors.initials: E
authors.lastname: Monteiro
authors.forename: Jetan
authors.initials: J
authors.lastname: Badhiwala
authors.forename: John
authors.initials: J
authors.lastname: Lee
authors.forename: John R
authors.initials: JR
authors.lastname: de Almeida
authors.forename: Allan
authors.initials: A
authors.lastname: Vescan
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Witterick
mesh_terms: D000328:Adult; D000818:Animals; D004724:Endoscopy; D006801:Humans; D009300:Nasal Septum / Q000601:surgery*; D009668:Nose Diseases / Q000601:surgery*; D011788:Quality of Life; D019651:Plastic Surgery Procedures; D012225:Rhinoplasty; D016896:Treatment Outcome