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Characterization of the Saddle Nose Deformity Following Endoscopic Endonasal Skull Base Surgery
Erin Anstadt MD, Wendy Chen MD MS, James O'Brien BS, Ilana Ickow DMD MS, Ian Chow MD, Jesse Goldstein MD, Barton F. Branstetter IV, MD, Carl Snyderman MD MBA, Eric W.Wang MD, Paul Gardner MD, Lindsay Schuster DMD MS
University of Pittsburgh Medical Center
2020-02-13
Presenter: Erin Anstadt MD
Affidavit:
Vu Nguyen
Director Name: Vu Nguyen
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Background/Purpose:
Skull base surgeons commonly employ the endoscopic endonasal approach (EEA) and reconstructive techniques to manage CSF leaks. Nasal deformity following the EEA is described, however detailed qualitative and quantitative assessments of the associated saddle nose deformity (SND) do not exist.
Methods:
A retrospective review of patients with SND after EEA for resection of skull base tumors over a 5-year period was conducted. Fifteen measurements related to the SND were obtained on pre-and post-operative imaging. Statistical analysis evaluated for significant differences between pre- and post-operative anatomy, and compared these values to expected normals. Sub-analysis was performed with stratification by reconstruction type.
Results:
20 patients were included. The most common EEA was bilateral transsellar (n=13). Reconstruction type: This cohort had 10 free mucosal grafts, 9 vascularized NSFs, one abdominal fat graft and one fascia lata graft. Imaging analysis: Mean loss of dorsal nasal height was 0.13mm. Sub-analysis by reconstruction type showed that in patients with nasoseptal flaps (n=9), average nasal tip projection was significantly decreased by 1.2mm (p = 0.039), and alar base width increased by 1.2mm (p=0.046). No significant differences were seen on sub-analysis of patients with free mucosal graft skull base coverage (n=10).
Conclusion:
While EEA is an effective tool for skull base surgery, patients are at risk for SND. In contrast to patients with free mucosal graft coverage alone, those with NSFs displayed significant loss in nasal tip projection and an increase in alar base width. Future analysis may include using 3D photography to assess 3D volumetric changes.
