Nasal Morbidity Associated with Expanded Endonasal Approaches to the Skull Base

Introduction: Expanded endonasal approaches (EEA) to the skull base are becoming an accepted surgical option for selected pathology involving the skull base. The purpose of this study is to review the nasal morbidity associated with this surgical approach.

Methods: We enrolled 100 patients in a prospective cohort study examining the nasal morbidity associated with EEA of the ventral skull base. Time to mucosalization of nasal cavity, degree and duration of crusting, palatal hypoesthesia, synechiae formation, incidence of sinusitis, and alar skin injury were assessed. Physical examination findings and patient questionnaire were the tools used for compiling data.

Results: The incidence of significant nasal morbidity is rare. Mucosalization of the surgical site was usually complete within 3 months. Delayed healing was noted in the presence of fat grafts due to partial necrosis and delayed separation of the eschar. Rapid healing with decreased crusting of the surgical site was noted with the use of nasal septal mucosal flaps for reconstruction. There were no anterior septal perforations despite the use of septal mucosal flaps. Palatal hypoesthesia was transient. No scarring of the anterior nares or alar skin was encountered. Acute sinusitis was rare and was usually associated with retained nasal crusts. A subset of patients have chronic crusting that requires ongoing saline irrigations.

Conclusions: With the increased acceptance of EEA approaches to the skull base, it is important to establish the incidence and types of nasal morbidities. Most morbidities are transient and minor. Reconstruction with a septal mucosal flap may limit nasal crusting.