Clinical and histologic studies of olfactory outcomes after nasoseptal flap harvesting

Abstract

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.

Olfaction in Endoscopic Sinus and Skull Base Surgery

“…Of the 19 biopsy specimens that contained olfactory epithelium, 10 had an influx of lymphocytes, macrophages, and eosinophils. Seven of these 10 patients (70%) had an abnormal UPSIT score (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31). Of the 12 patients with a normosmia (UPSIT score >35), only 3 (25%) had an inflammatory response.…”

“…The heat dispersion when using cautery may cause unintentional damage to the surrounding mucosa compared with a cold knife. 18 In a small cohort of 15 patients, Kim and colleagues 18 reported that 0 of 8 patients had a worsened BTT with cold knife compared with 1 of 7 with monopolar cautery 3 months after surgery. However, there was no significant reduction in the mean BTT or CCSIT olfactory tests in either of the groups.…”

“…4,[12][13][14] Addressing olfaction is also important before endoscopic endonasal skull base surgery, because smell loss may occur during tumor resection or harvest of a large nasoseptal flap for reconstruction. [15][16][17][18] In a survey of practicing otolaryngologists, roughly 40% routinely discuss the potential for postoperative anosmia with patients. 11 This figure is important because 17% of malpractice litigation cases from ESS pertain to smell loss or complete anosmia.…”

Posterosuperior extension of caudal septal incision for endoscopic septoplasty

“…However, our previous experience of development of the nasoseptal flap during endoscopic pituitary surgery provided us confidence that an additional incision can be made safely by using a cold knife. 8 As shown above, no significant olfactory injury occurred by our modified technique. Additionally, no other significant sequelae related to this modification were observed, including intraoperative or postoperative bleeding, delayed wound healing, synechia, and nasal septal perforation.…”

The Olfactory Strip and Its Preservation in Endoscopic Pituitary Surgery Maintains Smell and Sinonasal Function

“…Comparison with studies reporting expanded techniques that intentionally transverse the posterior cribriform area do not allow a good comparison of olfactory disturbance because the olfactory morbidity is anticipated as a result of this approach. 18 Kim et al described differing outcomes based on cold dissection versus electrocautery, 19 noting that olfactory impairment was uncommon and reported in only one patient with impairment in their series. The premise that thermal injury might contribute highlights the fact that a defined area of olfactory-bearing septal mucosa exists.…”