Sinonasal Outcomes following Endoscopic Skull Base Surgery with Nasoseptal Flap Reconstruction: A Prospective Study

Background: The nasoseptal flap may be used as a pedicled vascularized flap to repair the skull base defects created during surgery. However, this approach may lead to significant nasal morbidity in the postoperative setting.

Aim: To prospectively assess the nasal morbidity caused by the repair of skull base defects using the nasoseptal flap.

Methods: Thirty-six patients were assessed preoperatively and 90 days postoperatively via SNOT 20, as well as visual analog scores for nasal obstruction, pain, secretions, and smell, In addition, endoscopic findings and mucociliary clearance times were considered. Data analysis was performed using the Wilcoxon signed rank test.

Results: Nineteen patients had the nasoseptal flap raised from the left and 17 from the right. SNOT 20 and VAS scores for pain, smell, and secretion analysis showed no significant difference between pre- and 90-day postoperative scores. However VAS for nasal obstruction showed a statistically significant improvement in preoperative and postoperative scores (P = 0.0007). However, endoscopic scores for both the nasoseptal flap and non-flap side showed a statistically significant deterioration on examination findings (P = 0.002 and P = 0.02, respectively). Mucociliary clearance times were not significantly different postoperatively.

Conclusion: Our results suggest subjective significant clinical deterioration on nasal examination as one would expect in the postoperative setting. However, patient quality-of-life outcomes suggest no such significant differences at 3 months postoperatively. This study also suggests a significant improvement in airway following the nasoseptal flap reconstruction and no delay in mucociliary clearance times with short-term nasal morbidity following nasoseptal flap reconstruction.