Anatomic Changes Caused by Endoscopic Endonasal Transsphenoidal Surgery and Their Effects on Nasal Functions

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We evaluated postoperative changes in nasal cavity dimensions and their effects on nasal functions and symptoms.

Study Design

Case series with chart review.


Tertiary referral center.

Subjects and Methods

We studied patients who underwent binostril, 4-hand endoscopic endonasal transsphenoidal approach surgery with the bilateral modified nasoseptal rescue flap technique. Pre- and postoperative paranasal computed tomography scans were used to assess nasal cavity dimensional changes at 4 levels. We also performed several pre- and postoperative tests, including the Connecticut Chemosensory Clinical Research Center test and the Cross-Cultural Smell Identification Test (n = 119) to evaluate olfactory functions. Also, the Nasal Obstruction Symptoms Evaluation, the Sino-Nasal Outcome Test–20, and a visual analog scale were used (n = 157) to record subjective symptoms. We compared these data with the pre- and postoperative nasal cavity dimensions.


Two-dimensional objective increases in nasal passage dimensions were evident postoperatively (all cross-sectional areas, P < .001, except choana and left inferior turbinate). However, these did not correlate with subjectively assessed symptoms (Nasal Obstruction Symptoms Evaluation, all cross-sectional areas, P ≥ .05, except right middle turbinate; Sino-Nasal Outcome Test–20, all cross-sectional areas, P ≥ .05) or olfactory dysfunction evaluated with the Connecticut Chemosensory Clinical Research Center test (all cross-sectional areas, P ≥ .05) or the Cross-Cultural Smell Identification Test (all cross-sectional areas, P ≥ .05).


Endoscopic endonasal transsphenoidal approach surgery altered the patients’ nasal anatomy, but the changes in nasal cavity dimensions did not affect nasal functions and symptoms. These results will help surgeons to appropriately expose the surgical field during endoscopic endonasal transsphenoidal approach surgery.

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