Prospective characterization of postoperative nasal deformities in patients undergoing endoscopic endonasal skull‐base surgery

Abstract

Background Surgeons have become increasingly aware of the impact of endoscopic endonasal surgery (EES) of the skull base on sinonasal‐related quality of life. Prior retrospective investigation described a correlation between nasoseptal flap (NSF) reconstruction in EES with postoperative nasal deformities, such as nasal dorsum collapse. The primary objective of this study was to prospectively evaluate the incidence of, and contributing factors to, postoperative changes in nasal structure following EES. Secondary goals included assessing subjective changes in nasal appearance as well as objective nasal analysis. Methods Clinical demographics and detailed perioperative information was prospectively collected for patients undergoing transsellar/suprasellar EES for skull‐base tumors. Preoperatively, 1‐month and 6‐month photographs were completed for objective photographic nasal analysis and blinded assessment by surgeons. Subjective patient feedback was also solicited. Results Overall, 14.7% (5/34) of patients subjectively reported postoperative nasal deformities, whereas both blinded‐surgeon and objective nasal measurements identified deformities in 12.9% (4/31) of patients. Patients with postoperative deformities were more likely to have skull‐base reconstruction with an NSF (p = 0.01) and trended toward an increased incidence in patients with nonpituitary neoplasms (p = 0.07). There were no other associations between clinical or operative characteristics and external deformities. No patients planned to undergo corrective repair. Conclusion External nasal deformities following EES are more frequent than previously acknowledged. Postoperative deformities appear to be associated with NSF reconstruction and may be associated with surgery for nonpituitary neoplasms. Patients should be counseled on this potential outcome, and future studies should investigate how to minimize postoperative sequela.

Optimizing Quality of Life and Minimizing Morbidity through Nasal Preservation in Endoscopic Skull Base Surgery: A Contemporary Review

“…The only significant association factor was reconstruction with a NSF. 26 The authors point to reduced vascularity of the residual septal cartilage as a likely culprit for the changes in external appearance.…”

Impact of Reverse Septal Flap on Morbidity of Nasoseptal Flap Reconstruction of Skull Base Defects

“…Using Adobe Illustrator CC 2018, the analysis of photographs was performed with measurements of several facial angles, including nasofrontal angles, nasolabial angles, and nasofacial angles in addition to nasal proportion ratios using Goode's triangle (Figure 2). Analysis of the angulation of the nasal dorsum was performed using the same approach performed by Rowan et al, 6 which was done for characterization of a similar postsurgical population.…”

Endoscopic Endonasal Skull Base Surgery Complication Avoidance: A Contemporary Review

“…Most quality-of-life studies have emphasized sinonasal morbidity however there has been recent emphasis in the aesthetic complications of the EEA [ 161 , 162 ]. External nasal deformities such as saddle nose deformity are more common than previously thought and seem to be most associated with NSF reconstruction and non-pituitary neoplasm surgery.…”

“…External nasal deformities such as saddle nose deformity are more common than previously thought and seem to be most associated with NSF reconstruction and non-pituitary neoplasm surgery. The exact etiology of nasal dorsum collapse is not known but proposed techniques for minimizing its risk include preservation of septal mucosa and general minimization of NSF comorbidities through techniques such as free mucosal grafts, “reverse flap” technique, xenoplastic grafting, and silastic splinting [ 147 , 161 , 163 , 164 , 165 ].…”