Preserving Olfactory Function in Anterior Craniofacial Surgery through Cribriform Plate Osteotomy Applied in Selected Patients

Abstract

Olfaction can be preserved in selected patients undergoing anterior craniofacial surgery. At least 1 cm of nasal mucosa should remain attached to the cribriform plate, which can be achieved by including the nasal bone in the osteotomy of the orbital bar. A medial orbital canthopexy is therefore necessary after these procedures.

The radical transbasal approach for resection of anterior and midline skull base lesions

“…By adding a cribriform plate osteotomy in selective cases, olfaction could be preserved in most cases. 8 The mean hospital stay was 14.1 days. Thirty-eight patients were discharged home.…”

An Effective Method of Frontal Sinus Reconstruction After Bifrontal Craniotomy: Experience with 103 Patients

“…B ifrontal craniotomy is effective for the treatment of anterior skull base tumors (5,6,16,18) and anterior cerebral artery aneurysms (1,4,13,18,21,32). However, the frontal sinus (FS) is often opened during this surgery, and various postoperative complications may occur as a result of the open FS, including cerebrospinal fluid (CSF) leakage and infection (e.g., meningitis, brain abscess, subdural abscess, epidural abscess, and subcutaneous or subperiosteal abscess) (5,8,10,17,18,20,22,25,26,32).…”

“…However, the frontal sinus (FS) is often opened during this surgery, and various postoperative complications may occur as a result of the open FS, including cerebrospinal fluid (CSF) leakage and infection (e.g., meningitis, brain abscess, subdural abscess, epidural abscess, and subcutaneous or subperiosteal abscess) (5,8,10,17,18,20,22,25,26,32). The mucosa of the FS tends to form mucocele, especially if the nasofrontal duct (NFD) is obstructed.…”

“…Numerous methods for obliteration of the FS have been reported, including the use of fat, fascia, muscle, galeal or pericranial flap, bone, and titanium plates (2-4, 6, 8, 11, 16, 23-25, 30). However, CSF leakage and infection are major postoperative problems, with reported frequencies of 2%e20% and 3%e20%, respectively (5,8,10,17,18,20,22,25,26,32). More effective methods for FS reconstruction are needed to decrease the complication rate.…”

Diseases of the nasal cavity

“…When compared to more limited transphenoidal approaches to the pituitary, EEA patients report significantly greater loss in smell postoperatively though this finding has not replicated with objective olfactory evaluation. Though olfactory preserving techniques have previously been described for open skull base approaches (Spetzler et al, 1993;Dare et al, 2001;Honeybul et al, 2001;Feiz-Erfan et al, 2005), an increasing awareness regarding potential olfactory sequela following endoscopic skull base surgery has prompted a plethora of literature describing endoscopic techniques for sparing olfactory dysfunction in these patients. These techniques include preservation of the septal olfactory strip (Griffiths et al, 2014;Harvey et al, 2015) and use of the cold knife (Kim et al, 2013;Hong et al, 2014) (vs electrocautery) during nasoseptal flap harvest in addition to curtailing the routine resection of normal sinonasal structures such as the middle turbinates (Thompson et al, 2014).…”