Background <p>Septoplasty is a common treatment for septal deviation in otolaryngology, and it is the recommended treatment for a deviated septum. However, it can lead to post-operative complications such as septal hematoma, adhesions, and perforation. Trans-septal quilting suture and intranasal silicone splinting effectively prevent complications after septoplasty.</p> Aim <p>This systematic review and meta-analysis aimed to evaluate the effectiveness of intranasal silicone splints compared to quilting sutures in managing post-septoplasty complications and patient tolerance.</p> Materials and Methods <p>PubMed, Google Scholar, and CENTRAL databases were used with specific keywords, and the studies were screened using the Rayyan AI system and were selected based on the inclusion and exclusion criteria. Statistical analysis was done by using RevMan version 5.4 to generate forest plots. Regarding quality assessment, the JBI Critical Appraisal Tool for Systematic Reviews was used to evaluate the rigor of the included studies.</p> Results <p>This systematic review and meta-analysis identified 23 studies and only 18 were eligible. It showed that the three methods effectively prevent post-septoplasty complications; however, quilting sutures reduce post-operative pain and minimize the complications. It is essential to note that quilting sutures and intranasal splints showed a comparable incidence of nasal bleeding postoperatively to nasal packing.</p> Conclusion <p>It was found that trans-septal quilting sutures had considerable advantages over nasal packing in septoplasty procedures and clearly showed that it is a safe and effective technique. Nasal splints, specifically intranasal silicone splints, are indicated as an alternative to nasal packing to generally improve the patient’s comfort, especially by reducing post-operative discomfort. The findings of the study can help medical practitioners make better decisions about the most effective surgical approach, also considering well-tolerated post-septoplasty care.</p> Level of Evidence I <p>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 <a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>