Transcolumellar Approach in Transsphenoidal Pituitary Surgery for Patients with Small Nostril

Abstract

OBJECTIVE: Sublabial approach has been widely used as the standard technique for transsphenoidal pituitary surgery. But it has several possible drawbacks, such as; postoperative flat nose deformity, hypesthesia of upper gum, and feeding difficulty until 2 to 3 weeks after surgery. As an alternative, an endonasal approach was adopted for patients who had large nostrils, such as white or acromegalic patients. In patients with small nostrils, especially oriental people, it requires an additional tension release incision that leaves a definitely visible scar at the base of nose. STUDY DESIGN: We applied the transcolumellar approach, which modified the external rhinoplasty approach on the 136 cases of transsphenoidal pituitary surgery that were performed from 1994 to June 1999. RESULTS: In all patients, we found we could reach the anterior portion of nasal septum in 7 to 8 mm in depth from the skin surface and eliminate the disadvantages of sublabial and endonasal approach. Also, this method can markedly reduce the surgical dissection time and blood loss. CONCLUSIONS: We concluded that this technique was relatively simple and more than adequate in most transsphenoidal pituitary surgery, even in patients with small nostrils.