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

January 25th, 2016

Richard J. Harvey, Mark Winder, Andrew Davidson, Tim Steel, Sunny Nalavenkata, Nadine Mrad, Ali Bokhari, Henry Barham, Anna Knisely (J Neurol Surg B 2015; 76(06): 464-470)

Olfactory Strip

The return of olfaction and of sinonasal function are important end points after pituitary surgery. Differing outcomes on olfaction have been reported from transsphenoidal approaches. In general, patients prefer the endoscopic approach, and olfactory scores are better after the endoscopic route. The nasoseptal flap, in particular, to reconstruct the skull base as part of the overall process has been implicated in smell dysfunction. However, much of the literature on the impact of the nasoseptal flap comes from extended skull base surgery. Controversy exists as to the additional morbidity of utilizing such an approach. This study presents the sinonasal, smell, and objective olfactory outcomes of a standardized olfactory strip preserving nasoseptal flap technique utilized in the endoscopic endonasal transsphenoidal approach to pituitary pathology.

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Grading Facial Nerve Function Following Combined Static and Mimetic Surgical Techniques

January 22nd, 2016

John P. Leonetti, Sam J. Marzo, Douglas A. Anderson, Joshua M. Sappington (J Neurol Surg B 2015; 76(06): 416-420)

Facial paralysis has a profound functional, cosmetic, and psychological impact on affected patients. A variety of facial nerve grading systems have been described in the literature. The most commonly used grading method is the House-Brackmann grading scale that was adopted by the American Academy of Otolaryngology-Head and Neck Surgery in 1985. Other notable facial grading scales include the Sunnybrook, Yanagihara, Nottingham, and Sydney. The most commonly used facial nerve grading systems were designed to assess progressive neural recovery with an anatomically intact facial nerve. In their initial paper, House and Brackmann state that their facial nerve grading scale was intended to assess facial nerve recovery of an intact nerve. Patients who undergo surgical procedures for advanced lateral skull base tumors that require facial nerve and adjacent musculature resection and cases of long-standing facial nerve paralysis often require multiple static and mimetic procedures to optimize cosmetic result and return of long-term function. These can include the use of free muscle transfer, in conjunction with neural grafting, oculoplastic techniques, and static soft tissue tightening procedures. Existing facial recovery grading scales do not accurately assess this patient population. Individuals in this population are often automatically assigned a House-Brackmann score of 3 or 4. This void prevents clinicians from properly describing and communicating facial reanimation in this unique patient population.

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