Nasal Deformities following Nasoseptal Flap Reconstruction of Skull Base Defects

Introduction: Research involving the morbidity of endoscopic endonasal surgery (EES) of the skull base has focused on major complications such as cerebrospinal fluid leak and hemorrhage. Little attention has been paid to esthetic complications of EES, specifically nasal deformities such as nasal dorsum collapse. We sought to identify the prevalence and risk factors for nasal deformities after EES.

Study Design: This study is a case series.

Methods: Retrospective chart review from January 2011 to November 2013 of all EES of the skull base at a tertiary care academic medical center. Patient demographics, surgical approach and methodology, pathology, and postoperative clinical examinations were compared.

Results: A total of 333 patients were identified, 151 in which nasoseptal flaps were used. Overall, 18 (5.4%) patients were found to have nasal dorsum collapse, 3 (0.9%) with new septal perforations and 2 (0.6%) with postoperative septal deviations requiring surgical correction. No significant differences in basic demographics including sex, height, weight, and body mass index were obtained. There was no statistical difference in pathologies between patients with and without nasal deformities. Postoperative nasal deformities were found only in patients with nasoseptal flap reconstruction. Of the 151 patients who underwent nasoseptal flap reconstruction, 128 (84.8%) were without esthetic nasal changes, while 23 (15.3%) patients had postoperative nasal deformities (p = 0.0001). All patients with nasal deformities had extended skull base approaches involving multiple skull base anatomical subsites. Meanwhile, no patients with nasal deformities had undergone isolated transcribriform or transsellar access.

Conclusion: This is the first study to describe nasal deformities following EES. All deformities were associated with an extended approach involving multiple skull base anatomical subsites and the use of a nasoseptal flap for reconstruction, suggesting that nasoseptal flap size may play a role in the development of nasal deformities. The mechanism of nasal dorsum collapse is unclear but does not appear to be related to septal cartilage necrosis. These findings warrant prospective analysis to identify risk factors for nasal deformities postoperatively and provide data for counseling of patients.