No abstract

The term "gossypiboma" refers to a mass of the cotton matrix that is left in the body following an operation. It can remain silent postoperatively and appear several years later with a variety of symptoms or non-specific radiological findings. In addition, gossypiboma that persists in the human body for a long time can cause many complications when surgically removed. We report the case of a 33-year-old man who underwent rhinoseptoplasty and presented with nasal obstruction by a foreign body sensation. On endoscopic examination, protruding fabric material and granulation tissue were detected in the medial portion of the left nasal septum. Severe adhesion between the gossypiboma and septal mucosa resulted in a significant defect in the septal mucosa after endoscopic removal. The septum was approximated and reconstructed using a posterior-based inferior turbinate flap. The nasal obstruction completely resolved after surgery, and the septum healed at the six-month follow-up. This case emphasizes the possibility of gossypiboma when missing gauze remains in the patient after rhinoseptoplasty and a large septal perforation occurs as a consequence of gossypiboma removal. Rhinoplasty surgeons should be cautious to prevent materials being left inside the patient and efficiently follow-up on patients with nonspecific postoperative complaints.

Background and Objectives:The endoscopic transsphenoidal approach (TSA) is the standardized surgical approach to sella lesions providing a wider field and resulting in fewer neurosurgical complications. However, sinonasal complications are relatively less studied. This study aims to analyze sinonasal morbidities after endoscopic TSA performed by a single center. Materials and Methods: Among 154 patients who underwent endoscopic TSA from 2015 to 2022, 107 patients who were followed up for more than 3 months were included and retrospectively reviewed. Sinonasal complications including crust, discharge, septal perforation, synechia and polypoid sphenoid mucosa at postoperative 3 month were evaluated with olfactory function. The patients were subdivided into nasoseptal flap (NSF), non-NSF, 1st phase (initial 3 years, n=53) and 2nd phase (later 4 years, n=54) groups for further analysis. Results: There were 47 male (43.9%) with a mean age of 51.6 (range 15-83). The mean follow-up duration was 10.9 (range 3-46) months. Crust (28, 26.2%) was the most frequent morbidity followed by synechia (18, 16.8%), hyposmia (17, 15.9%), discharge (14, 13.1%), polypoid sphenoid mucosa and septal perforation (8, 7.5%). NSF was associated with crust formation and septal perforation (p<0.001). Olfactory function was relatively preserved at 3 month (p=0.065). Postoperative cerebrospinal fluid (CSF) leak decreased in the 2nd phase (4/54, 7.4%) compared to the 1st phase (12/53, 22.6%) (p<0.05). Conclusion: Crust was the most frequent sinonasal morbidity after endoscopic TSA followed by synechia. NSF was associated with crust and septal perforation. Post-op CSF leaks could be reduced after overcoming the learning curve of endoscopic TSA.