APS Aesthetic Plastic Surgery · 2023

Role of External Nasal Splinting Following Rhinoplasty: Is It Really Important? A Comprehensive Systematic Review of Literature

Khan M, Mortada H, AlRajhi B, Alwagdani A, Almosa W, Almolhim K, Obeid AA, Neel OF.

PubMed 36964289 Publisher (DOI)Free full text (PMC)

What this paper says

A systematic review of four studies concluded that the external nasal cast placed after rhinoplasty should not be used routinely, because no clear evidence shows it reduces complications.

Overview

An external nasal splint is the cast taped over the nose after surgery, intended to hold the reshaped cartilage and repositioned bone in place. Its use is near universal, but the authors state the evidence behind it is thin. They searched Cochrane, Medline and Embase in September 2022, with two reviewers screening independently, using search terms covering rhinoplasty, septorhinoplasty, osteotomy and splinting.

Sections of note

Design: systematic review. Level of evidence III as assigned by the journal.
1617 articles were identified; only 4 met criteria for the final review, all published between 2016 and 2021.
The included studies covered 2425 patients. The abstract states 20 used external splints and 2415 did not, which sums to 2435 rather than 2425. The paper's own numbers are inconsistent.
Among the 2415 patients without a splint, 151 had moderate periorbital swelling and bruising.
A decrease in nasal width was reported in 99 percent of patients who did not use an external splint.
Complications occurred in both splinted and unsplinted patients.
Stated conclusion: splinting should be reserved for selected patients rather than used routinely, and further studies are needed.

What it means for a patient

Going without a nasal cast did not prevent the nose from narrowing after surgery in these studies.
The evidence is very lopsided. Only about 20 patients across the whole review actually used a splint, so any comparison rests on a tiny splinted group.
The recommendation to reserve splinting for selected patients is not accompanied by criteria for which patients those are.
Limits: four studies, unbalanced groups, an internal inconsistency in the reported patient count, and no randomized trial included.

Why this paper matters

Postoperative splinting is one of the most entrenched habits in rhinoplasty, applied to nearly every patient, yet almost never tested. This review shows how little data supports it. A randomized comparison with balanced groups has not been done.

Terms

External nasal splint: the rigid cast taped over the outside of the nose after surgery.
Septorhinoplasty: nose surgery that reshapes the outside and straightens the septum.
Osteotomy: a planned cut or controlled fracture of the nasal bones.
Periorbital edema and ecchymosis: swelling and bruising around the eyes.
Systematic review: a structured search and appraisal of all studies meeting set criteria.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

Abstract

Background: Following rhinoplasty, external nasal splints are used to reshape the cartilage and reposition the nasal bone. Despite the popularity of using an external nasal splint in rhinoplasty procedures, there is still a lack of evidence of the effectiveness of using the external nasal splint post-rhinoplasty. This systematic literature review aimed to evaluate the evidence regarding the use of external nasal splints following rhinoplasty.

Methods: A systematic search of Cochrane, Medline, and Embase databases was conducted in September 2022. The literature was screened independently by two reviewers, and the data were extracted. Our search terms included septorhinoplasty, rhinoplasty, osteotomy, splinting, nasal splinting, and external nasal splinting.

Results: Initially, 1617 articles were identified, but only four articles were included in the final review. The included studies were all published between 2016 and 2021. The included studies recruited 2425 patients, 20 of whom used external splints and 2415 did not. Out of 2415 patients who did not use an external nasal splint, there were 151 patients with moderate periorbital edema and ecchymosis. There was a decrease in nasal width in 99% of the patients who did not use external nasal splinting postoperatively.

Conclusion: According to our findings, nasal splinting should not be routinely used following rhinoplasty, but only in certain patients. There is no clear evidence that nasal splints reduce complications, and complications occurred among both patients with and without external nasal splints. Further studies need to be conducted to confirm this conclusion.

Level Of Evidence Iii: 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 .

Abstract as indexed by PubMed; the article is open access (PubMed Central).