Pacific Neuroscience Institute & Pituitary Disorders Program, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, California, USA.
Inland Neurosurgery Institute, Pomona, California, USA.
Otolaryngol Head Neck Surg. 2019 Nov;161(5):881-889. doi: 10.1177/0194599819861340. Epub 2019 Jul 23.
To ascertain the impact of septal olfactory strip preservation and bilateral rescue flap elevation on the incidence of olfactory dysfunction.
Case series with chart review of patients undergoing endoscopic endonasal skull base surgery (2012-2014).
Providence Saint John's Health Center and John Wayne Cancer Institute.
The incidences of postoperative epistaxis, hyposmia, and anosmia were analyzed using the Brief Smell Identification Test (B-SIT), which was completed in 110 of the 165 patients.
Seventy-eight patients required extended approaches. Bilateral nasoseptal rescue flaps were elevated in 144 patients (87.3%) and pedicled nasoseptal or middle turbinate flaps in 21 patients (12.7%). The neurovascular pedicles were preserved in all patients, and there were no episodes of postoperative arterial epistaxis. Normal olfaction was noted in 95 patients (86%), with new hyposmia noted in 5 patients (5.5%). Within the rescue flap cohort, new hyposmia occurred in 6.3% ( < .01) of patients, balanced by improvement of olfaction in 43% of patients with preoperative dysfunction (overall pre- and postoperative olfactory function: 85% vs 86%). Patients with pedicled nasoseptal flaps did not have new hyposmia, with a net improvement of olfaction (71% vs 86%, = .07). No patients experienced new anosmia. There was no difference between flap type within either subgroup.
Superior olfactory strip preservation during elevation of reconstructive flaps preserves olfactory function and maintains adequate surgical exposure. In addition, rescue flaps have significantly diminished the rate of arterial postoperative epistaxis while maintaining the ability to harvest nasoseptal flaps for future reconstruction.
确定保留鼻中隔嗅带和双侧救援瓣提升对嗅觉功能障碍发生率的影响。
对接受内镜鼻内镜颅底手术的患者进行病例系列和图表回顾（2012-2014 年）。
普罗维登斯圣约翰健康中心和约翰韦恩癌症研究所。
使用简短嗅觉识别测试（B-SIT）分析 165 例患者中的 110 例患者的术后鼻出血、嗅觉减退和嗅觉丧失发生率。
78 例患者需要延长手术。144 例患者（87.3%）升高双侧鼻鼻中隔救援瓣，21 例患者（12.7%）升高带蒂鼻中隔或中鼻甲瓣。所有患者均保留了神经血管蒂，无术后动脉性鼻出血发作。95 例（86%）患者嗅觉正常，5 例（5.5%）患者出现新的嗅觉减退。在救援瓣组中，6.3%（<0.01）的患者出现新的嗅觉减退，同时术前嗅觉障碍患者中 43%的嗅觉得到改善（总体术前和术后嗅觉功能：85%比 86%）。带蒂鼻中隔瓣患者无新的嗅觉减退，嗅觉改善（71%比 86%，=0.07）。没有患者出现新的嗅觉丧失。在任何亚组中，瓣类型之间均无差异。
在提升重建瓣时保留鼻中隔嗅带可保留嗅觉功能并保持足够的手术暴露。此外，救援瓣显著降低了术后动脉性鼻出血的发生率，同时保持了获取鼻中隔瓣进行未来重建的能力。
