====== External nasal deformity ======

[[Surgeon]]s have become increasingly aware of the impact of [[endoscopic endonasal surgery]] (EES) of the [[skull base]] on [[sinonasal]]-related [[quality of life]]. The prior retrospective investigation described a correlation between [[nasoseptal flap]] (NSF) reconstruction in EES with postoperative nasal deformities, such as [[nasal dorsum collapse]]. 

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[[Transsphenoidal surgery]] for [[sellar lesion]]s may affect patency and function of the [[nasopharyngeal airway]]s, [[smell]] and [[sinonasal]] [[quality of life]]. 

In a [[prospective]] [[study]], 68 [[patient]]s scheduled for [[transsphenoidal]] [[operation]]s (32 female, 36 male, age 17-72 years) underwent otorhinolaryngological [[evaluation]] of their nasal morphology, a standardized [[smell]] [[test]] ([[Sniffin’ Sticks test]]) and [[rhinomanometry]] to analyze [[nasal breathing]] function preoperatively, 3-5 days postoperatively (without rhinomanometry), after 3-4 months and after 9 months.

Immediately after surgery, a reduction in [[smell]] sensation was detected in almost all patients. Within 3 months, this impairment resolved in all cases except one. In 2 patients (3%) with preoperative [[anosmia]], improvement of smell function to > 6 out of 12 sniffin' sticks was observed. At the final visit, no patient was noted to have new anosmia. Within 3 months, the results of the rhinomanometry revealed that all patients except one regained their preoperative nasal breathing function. In 6 patients (8.8%) improvement in their nose breathing abilities compared to the preoperative state was found. Three patients (4.4%) underwent a LASER transection of mucosal [[synechia]]e. In one case with persistent [[nasal obstruction]] (1.5%), secondary [[septoplasty]] had to be performed. There was no case in which perforation of the [[nasal septum]], [[nasal tip]] deflection, or [[external nasal deformity]] was observed.

Microsurgical [[resection]] of [[pituitary tumor]]s via the [[endonasal]] [[transsphenoidal approach]] poses an acceptable [[risk]] with regards to [[sinonasal]] [[complication]]s. The [[incidence]] of secondary rhinosurgical interventions is low. Standardized comparative studies between endoscopic and microsurgical transsphenoidal operations should be undertaken
((Hondronikos N, Alomari A, Schrader M, Knappe UJ. Rhinological Consequences of 
Microsurgical Endonasal-Transsphenoidal Surgery for Pituitary Tumors. Exp Clin
Endocrinol Diabetes. 2020 May 7. doi: 10.1055/a-1155-6269. [Epub ahead of print] 
PubMed PMID: 32380562.
)).


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The primary objective of Rowan et al. was to [[prospective]]ly 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.

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.

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.

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
((Rowan NR, Valappil B, Chen J, Wang EW, Gardner PA, Snyderman CH. Prospective
characterization of postoperative nasal deformities in patients undergoing
endoscopic endonasal skull-base surgery. Int Forum Allergy Rhinol. 2019 Oct 30.
doi: 10.1002/alr.22466. [Epub ahead of print] PubMed PMID: 31665569.
)).

see also: [[Saddle nose]] deformity

===== References =====