Abstract：
BACKGROUND: The workhorse for endonasal reconstruction of skull base defects is the posteriorly-based nasoseptal flap (NSF). Postoperative nasal deformities and decreased olfaction are potential complications of NSF. The reverse septal flap (RSF) minimizes the donor site morbidity of the NSF by covering the exposed cartilage of the anterior septum. Currently, there are minimal data examining its effect on outcomes including nasal dorsum collapse and olfaction.
OBJECTIVE: Our study aims to clarify whether the RSF should be utilized when the option exists.
METHODS: Adult patients undergoing endoscopic endonasal approach (EEA) surgery of the skull base (transsellar/transplanum/transclival approaches) with NSF reconstruction were identified. Data from 2 separate cohorts, one retrospective and one prospective, were collected. Follow-up was at least 6 months. Patients were photographed preoperatively and postoperatively using standard rhinoplastic nasal views. Patients completed the University of Pennsylvania Smell Identification Test (UPSIT) and the 22-item Sino-Nasal Outcome Test (SNOT-22) preoperatively and postoperatively and were also queried regarding subjective changes in nasal appearance and plans for cosmetic surgery following EEA.
RESULTS: There were no statistically significant differences in the change in UPSIT and SNOT-22 scores between patients receiving RSF and other reconstructive groups (either NSF without RSF or no NSF). One of 25 patients who were reconstructed with an NSF with RSF reported a change in nasal appearance; none were considering reconstructive surgery. The proportion of patients reporting changes in appearance was significantly lower in the NSF with RSF group as compared to the NSF without RSF group (P = .012).
CONCLUSIONS: The use of an RSF to limit donor site morbidity of the NSF was shown to significantly decrease the proportion of patients who reported nasal deformities and did not show a significant difference in patient-reported sinonasal outcomes. Given these findings, RSF should be considered whenever an NSF is used for reconstruction.
OBJECTIVE: Our study aims to clarify whether the RSF should be utilized when the option exists.
METHODS: Adult patients undergoing endoscopic endonasal approach (EEA) surgery of the skull base (transsellar/transplanum/transclival approaches) with NSF reconstruction were identified. Data from 2 separate cohorts, one retrospective and one prospective, were collected. Follow-up was at least 6 months. Patients were photographed preoperatively and postoperatively using standard rhinoplastic nasal views. Patients completed the University of Pennsylvania Smell Identification Test (UPSIT) and the 22-item Sino-Nasal Outcome Test (SNOT-22) preoperatively and postoperatively and were also queried regarding subjective changes in nasal appearance and plans for cosmetic surgery following EEA.
RESULTS: There were no statistically significant differences in the change in UPSIT and SNOT-22 scores between patients receiving RSF and other reconstructive groups (either NSF without RSF or no NSF). One of 25 patients who were reconstructed with an NSF with RSF reported a change in nasal appearance; none were considering reconstructive surgery. The proportion of patients reporting changes in appearance was significantly lower in the NSF with RSF group as compared to the NSF without RSF group (P = .012).
CONCLUSIONS: The use of an RSF to limit donor site morbidity of the NSF was shown to significantly decrease the proportion of patients who reported nasal deformities and did not show a significant difference in patient-reported sinonasal outcomes. Given these findings, RSF should be considered whenever an NSF is used for reconstruction.
摘要：
背景：颅底缺损的鼻内重建的主力是后鼻中隔皮瓣（NSF）。术后鼻畸形和嗅觉下降是NSF的潜在并发症。反向间隔瓣（RSF）通过覆盖前间隔的暴露软骨，最大程度地减少了NSF的供体部位发病率。目前,研究其对包括鼻背塌陷和嗅觉在内的结局的影响的数据很少.
目的：我们的研究旨在阐明当存在该选项时是否应使用RSF。
方法：确定了接受内镜经鼻入路（EEA）颅底手术（经鞍式/经颅/经斜入路）和NSF重建的成年患者。来自2个独立队列的数据，一个回顾性和一个前瞻性，被收集。随访至少6个月。术前和术后使用标准的鼻整形鼻视图对患者进行拍照。患者在术前和术后完成了宾夕法尼亚大学气味鉴定测试（UPSIT）和22项鼻中结果测试（SNOT-22），并询问了鼻外观的主观变化以及EEA后的整容手术计划。
结果：接受RSF和其他重建组（无RSF的NSF或无NSF）的患者之间UPSIT和SNOT-22评分的变化无统计学意义。用RSF进行NSF重建的25例患者中有1例报告了鼻腔外观的变化；没有人考虑进行重建手术。与无RSF的NSF组相比，有RSF的NSF组报告外观变化的患者比例显着降低（P=0.012）。
结论：使用RSF来限制NSF的供体部位发病率显著降低了报告鼻畸形的患者比例，并且在患者报告的鼻窦结局方面没有显着差异。鉴于这些发现,每当使用NSF进行重建时，都应考虑RSF。
目的：我们的研究旨在阐明当存在该选项时是否应使用RSF。
方法：确定了接受内镜经鼻入路（EEA）颅底手术（经鞍式/经颅/经斜入路）和NSF重建的成年患者。来自2个独立队列的数据，一个回顾性和一个前瞻性，被收集。随访至少6个月。术前和术后使用标准的鼻整形鼻视图对患者进行拍照。患者在术前和术后完成了宾夕法尼亚大学气味鉴定测试（UPSIT）和22项鼻中结果测试（SNOT-22），并询问了鼻外观的主观变化以及EEA后的整容手术计划。
结果：接受RSF和其他重建组（无RSF的NSF或无NSF）的患者之间UPSIT和SNOT-22评分的变化无统计学意义。用RSF进行NSF重建的25例患者中有1例报告了鼻腔外观的变化；没有人考虑进行重建手术。与无RSF的NSF组相比，有RSF的NSF组报告外观变化的患者比例显着降低（P=0.012）。
结论：使用RSF来限制NSF的供体部位发病率显著降低了报告鼻畸形的患者比例，并且在患者报告的鼻窦结局方面没有显着差异。鉴于这些发现,每当使用NSF进行重建时，都应考虑RSF。
