Comparison between Rescue Flap and Double Flap Technique.

Area of Science:

• Otolaryngology
• Neurosurgery
• Surgical Innovation

Background:

• Endoscopic pituitary surgery often results in mucosal loss in the nasal cavity, specifically the sphenoethmoidal recess and posterior nasal septum.
• A gap exists in comparative literature regarding primary septal perforation reconstruction versus secondary healing following such procedures.

Purpose of the Study:

• To evaluate and compare postoperative patient morbidity after endoscopic endonasal pituitary surgery.
• To assess the outcomes of two reconstruction techniques: rescue flaps and double nasoseptal flaps, in patients with or without posterior septal perforation.

Main Methods:

• A prospectively randomized study was conducted with sixty participants at a tertiary academic center.
• Outcomes measured included functional breathing via visual analog scale (VAS), sphenoid sinusitis, synechia formation, posterior septal perforation presence, and sphenoethmoidal recess crusting.

Main Results:

• Both intact and perforated septum groups showed significant pre- to postoperative changes in VAS scores, with a more pronounced worsening in the posterior septal perforation group.
• The posterior septal perforation group experienced significantly more crusting compared to the intact septum group.
• While both groups had worsened VAS scores, the perforated group's decline was substantially greater.

Conclusions:

• This study is the first to compare postoperative morbidity in endoscopic endonasal pituitary surgery concerning posterior septal perforation.
• Reconstruction of the posterior septum, coupled with minimized mucosal loss, is associated with improved postoperative nasal symptom scores.
• The findings suggest that proactive septal reconstruction positively impacts patient recovery and functional outcomes.