Clinical and histologic studies of olfactory outcomes after nasoseptal flap harvesting

被引:41
作者
Kim, Sang-Wook [1 ,3 ]
Park, Kyung Bum [2 ,3 ]
Khalmuratova, Roza [1 ]
Lee, Hong-Kyoung [1 ]
Jeon, Sea-Yuong [1 ,3 ]
Kim, Dae Woo [4 ]
机构
[1] Gyeongsang Natl Univ Hosp, Dept Otorhinolaryngol, Jinju, South Korea
[2] Gyeongsang Natl Univ Hosp, Dept Neurosurg, Jinju, South Korea
[3] Gyeongsang Natl Univ, Inst Hlth Sci, Jinju, South Korea
[4] Seoul Natl Univ, Coll Med, Dept Otorhinolaryngol, Boramae Med Ctr, Seoul 156707, South Korea
关键词
Electrocoagulation; hypophysectomy; nasal surgical procedures; olfaction disorders; smell; surgical flaps; TRANSSPHENOIDAL PITUITARY SURGERY; DISORDERS; SCALPEL; MODEL;
D O I
10.1002/lary.24107
中图分类号
R-3 [医学研究方法]; R3 [基础医学];
学科分类号
1001 ;
摘要
Objectives/Hypothesis Since the introduction of an endonasal endoscopic approach in transsphenoidal pituitary surgery, reports of perioperative olfactory changes have presented conflicting results. We examined the incidence of olfactory loss in cases of endoscopic transsphenoidal pituitary surgery with skull base repair using the nasoseptal flap (NSF) and the effects of monopolar electrocautery commonly used in designing the NSF. Study Design Case-control study. Methods Fifteen patients who underwent endoscopic transsphenoidal pituitary surgery with skull base reconstruction using the NSF were divided into cold knife (n=8) and electrocautery (n=7) groups according to the device used in the superior incision of the NSF. Patients were followed regularly to monitor the need for dressing or adhesiolysis around the olfactory cleft. All subjects received olfactory tests before and 6 months after surgery. Septal mucosa specimens obtained during posterior septectomy were incised with different devices, and the degree of mucosal damage was evaluated. Results One patient in the electrocautery group demonstrated olfactory dysfunction postoperatively, but the other 14 patients showed no decrease in olfaction. In histologic analyses, 55.8% and 76.9% of the mucosal surface showed total epithelial loss when the mucosa was cut with cutting- and coagulation-mode electrocautery, respectively. In contrast, only 20% of the mucosal surface exhibited total epithelial loss when the mucosa was cut with a cold knife (P<.01). Conclusions Olfactory impairment is not common after use of the NSF. Use of the cold knife in making superior incision may reduce tissue damage with better olfactory outcomes.
引用
收藏
页码:1602 / 1606
页数:5
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