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Olfaction is a prominent entity that determines a person's quality of life. During human evolution, olfaction has played an essential role in determining safe food, assessing threats, and developing social relationships. Endoscopic endonasal surgeries are widely used today for the removal of brain tumors involving the pituitary and skull base. The minimal invasiveness, rapid recovery, better visualization, and lower occurrence of complication make endonasal endoscopic surgery an ideal approach for tumors involving the pituitary and midline skull base. However, the olfactory epithelium is at risk of injury during endoscopic skull base surgeries due to the orientation of the olfactory epithelium fibers.It has been found that the olfactory neuroepithelium extends from the cribriform plate superiorly to the septum for the superior-most 1 to 2 cm medially and onto the upper half of the superior turbinates laterally.It also extends from the face of the sphenoid posteriorly to the attachment of the middle turbinate anteriorly.This makes the olfactory fibers susceptible to injury during endonasal surgery that requires superior or upper limb septal incisions, such as the pedicled nasoseptal flap (the Hadad-Bassagasteguy flap) and modified nasoseptal rescue flap.It has been debated whether using a scalpel instead of cautery could have a differential effect on the olfaction of an individual, as some surgeons believe that the heat generated by a cautery injures the nearby olfactory mucosa.This study aims at determining the method which is better at preserving the olfactory capacity of an individual undergoing endoscopic endonasal skull base surgery.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group A | Experimental | During endoscopic endonasal skull base surgery,scalpel will be used to elevate the nasoseptal flap. |
|
| Group B | Active Comparator | During endoscopic endonasal skull base surgery,cautery will be used to elevate the nasoseptal flap. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Scalpel | Procedure | During endoscopic endonasal skull base surgery,scalpel will be used to elevate the nasoseptal flap. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Combined Olfactory Score (I-smell test) | Threshold odour identification score and specific odour identification score will be added to form a Combined Olfactory Score. | Preoperatively,Immediate postoperatively,3-6 months postoperatively |
| Visual Analogue Scale (VAS) | Visual analogue scale scoring from 0-10 to measure olfaction. (with higher score indicating better olfaction capacity) | Preoperatively,Immediately postoperatively,3-6 months postoperatively |
| Measure | Description | Time Frame |
|---|---|---|
| 22-item Sino Nasal Outcome Test (SNOT-22) questionnaire | It covers a range of sinonasal symptoms and their impact on social and emotional well-being | Preoperatively,Immediate postoperatively,3-6 months postoperatively |
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Inclusion Criteria:
-Patients undergoing endoscopic endonasal skull base surgeries that require the raising of a nasoseptal flap
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Ananya Srivastava, MBBS | Contact | +919672423734 | ananyasrivastava1008@gmail.com |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| All India Institute Of Medical Sciences | Recruiting | Jodhpur | Rajasthan | 342005 | India |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 23798331 | Result | Kim SW, Park KB, Khalmuratova R, Lee HK, Jeon SY, Kim DW. Clinical and histologic studies of olfactory outcomes after nasoseptal flap harvesting. Laryngoscope. 2013 Jul;123(7):1602-6. doi: 10.1002/lary.24107. Epub 2013 Mar 21. | |
| 30657649 | Result | Puccinelli CL, Yin LX, O'Brien EK, Van Gompel JJ, Choby GW, Van Abel KM, Janus JR, Stokken JK. Long-term olfaction outcomes in transnasal endoscopic skull-base surgery: a prospective cohort study comparing electrocautery and cold knife upper septal limb incision techniques. Int Forum Allergy Rhinol. 2019 May;9(5):493-500. doi: 10.1002/alr.22291. Epub 2019 Jan 18. |
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| ID | Term |
|---|---|
| D000086582 | Anosmia |
| ID | Term |
|---|---|
| D000857 | Olfaction Disorders |
| D012678 | Sensation Disorders |
| D009461 | Neurologic Manifestations |
| D009422 | Nervous System Diseases |
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| ID | Term |
|---|---|
| D053685 | Laser Therapy |
| D002425 | Cautery |
| ID | Term |
|---|---|
| D013812 | Therapeutics |
| D055011 | Ablation Techniques |
| D013514 | Surgical Procedures, Operative |
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| Cautery | Procedure | During endoscopic endonasal skull base surgery,cautery will be used to elevate the nasoseptal flap. |
|
| 25514489 | Result | Hong SD, Nam DH, Park J, Kim HY, Chung SK, Dhong HJ. Olfactory outcomes after endoscopic pituitary surgery with nasoseptal "rescue" flaps: electrocautery versus cold knife. Am J Rhinol Allergy. 2014 Nov-Dec;28(6):517-9. doi: 10.2500/ajra.2014.28.4109. |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |