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Published on: June 20, 2018
Success of Anterior Ethmoidal Artery Flaps for Nasal Septal Perforation Repair: A Systematic Review
Hemali P Shah1, Ethan Tsao2, Alhan Sayyed2
1Department of Otolaryngology-Head & Neck Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA.
Objective:
Nasal septal perforation (NSP) repair using the anterior ethmoidal artery (AEA) flap is an emerging endoscopic technique. This systematic review aimed to provide a comprehensive overview of the AEA flap technique, its variations, and its efficacy in repairing NSPs.
Data Sources:
MEDLINE, Embase, CENTRAL, and Web of Science were searched. This study was reported per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines from 1946 to 2026.
Review Methods:
The aforementioned search yielded 2838 results. Animal and cadaver studies, editorials, abstracts, and studies that did not address NSP repair with surgical flaps were excluded. After full-text review of 164 studies, 16 were included.
Results:
A total of 249 patients were captured (223 adults, 26 pediatric). For adults, 175 patients underwent the original AEA flap technique with (N = 74) or without (N = 101) an interposition graft, such as tragal cartilage, acellular dermal, or porcine collagen grafts. All pediatric and 48 adult patients underwent various modified AEA flap techniques. For the original AEA flap, mean reported NSP size ranged from 12.8 to 22 mm and postoperative follow-up time ranged from 3 to 51 months. Overall, NSP closure success rate was 84.6% (N = 148/175) for the AEA flap. Closure success rate was 83.8% (N = 62/74) for those with an interposition graft and 85.1% (N = 86/101) for patients without a graft (p = 0.81, Cramer's V = 0.02).
Conclusions:
With an overall closure success rate of 84.6%, the AEA flap is a reliable endoscopic technique for repairing NSPs < 2.5 cm. Emerging AEA flap modifications may further improve outcomes, while enabling repair of larger perforations.
Level Of Evidence:
N/A.
