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Long-term olfactory outcome after nasoseptal flap reconstructions in midline skull base surgery


Soyka, Michael B; Serra, Carlo; Regli, Luca; Meier, Eva; Holzmann, David (2017). Long-term olfactory outcome after nasoseptal flap reconstructions in midline skull base surgery. American Journal of Rhinology & Allergy, 31(5):334-337.

Abstract

BACKGROUND: The nasoseptal flap (NSF) is a universally used surgical technique to cover defects of the skull base after extended sinonasal surgery. Long-term follow-up of complications, sequelae, and smell function is largely unknown.
OBJECTIVE: The main objective of this study was to investigate monorhinal olfaction after transsphenoidal skull base surgery.
METHODS: Patients who underwent skull base surgery for midline lesions (craniopharyngioma and pituitary tumors) by using a NSF, also referred to as the Haddad flap, were assessed for their long-term outcome. Endoscopic examination was conducted and the bilateral "Sniffin' Sticks" test was performed before surgery. Each side was tested separately in the postoperative follow-up consultation.
RESULTS: Twenty patients were included in the study. No flap failures were observed. One anterior perforation and one small posterior septal perforation were found during long-term follow-up. None of the patients had nasal breathing impairment, whereas two patients had nose bleeds. A significant decrease in olfactory function was observed on the flap donor side in four patients (20%) compared with that observed in one patient (5%) on the opposite side.
CONCLUSION: NSF reconstructions for midline lesions were efficient and safe in the long term. Olfactory impairment on the donor side was frequently encountered. Although subclinical, these findings justified a monorhinal smell testing before surgery, which possibly prevented bilateral smell impairment in patient with preexisting single-sided olfactory loss.

Abstract

BACKGROUND: The nasoseptal flap (NSF) is a universally used surgical technique to cover defects of the skull base after extended sinonasal surgery. Long-term follow-up of complications, sequelae, and smell function is largely unknown.
OBJECTIVE: The main objective of this study was to investigate monorhinal olfaction after transsphenoidal skull base surgery.
METHODS: Patients who underwent skull base surgery for midline lesions (craniopharyngioma and pituitary tumors) by using a NSF, also referred to as the Haddad flap, were assessed for their long-term outcome. Endoscopic examination was conducted and the bilateral "Sniffin' Sticks" test was performed before surgery. Each side was tested separately in the postoperative follow-up consultation.
RESULTS: Twenty patients were included in the study. No flap failures were observed. One anterior perforation and one small posterior septal perforation were found during long-term follow-up. None of the patients had nasal breathing impairment, whereas two patients had nose bleeds. A significant decrease in olfactory function was observed on the flap donor side in four patients (20%) compared with that observed in one patient (5%) on the opposite side.
CONCLUSION: NSF reconstructions for midline lesions were efficient and safe in the long term. Olfactory impairment on the donor side was frequently encountered. Although subclinical, these findings justified a monorhinal smell testing before surgery, which possibly prevented bilateral smell impairment in patient with preexisting single-sided olfactory loss.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Neurosurgery
Dewey Decimal Classification:610 Medicine & health
Uncontrolled Keywords:Haddad flap; Olfaction; long term; monorhinal; nasoseptal flap; outcome; skull base surgery
Language:English
Date:1 September 2017
Deposited On:20 Sep 2017 19:53
Last Modified:20 Sep 2017 19:53
Publisher:OceanSide Publications
ISSN:1050-6586
Publisher DOI:https://doi.org/10.2500/ajra.2017.31.4463
PubMed ID:28859712

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