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Randomized Controlled Trial
. 2025 May;282(5):2437-2445.
doi: 10.1007/s00405-025-09342-8. Epub 2025 Apr 12.

Functional sinonasal outcomes after rescue flap versus double nasoseptal flap in endoscopic trans-sphenoid pituitary surgery: a randomized clinical trial

Ahmad Muhammad Al-Arman  1 , Waleed Moneir  1 , Hazem Emam Amer  1 , Mahmoud Saad  2 , Hisham Atef Ebada  3
Affiliations
Randomized Controlled Trial

Functional sinonasal outcomes after rescue flap versus double nasoseptal flap in endoscopic trans-sphenoid pituitary surgery: a randomized clinical trial

Ahmad Muhammad Al-Arman et al. Eur Arch Otorhinolaryngol. 2025 May.

Abstract

Objectives: The aim of the current study was to evaluate the functional sinonasal outcomes after rescue flap versus double nasoseptal flap in endoscopic endonasal pituitary surgery.

Methods: This randomized clinical trial was conducted over 1.5 years over 60 patients who underwent endoscopic trans-sphenoid surgery for macroadenomas (more than 2 cm.). the patients were randomly allocated into 2 groups: the rescue flap group, (n = 30) and the double nasoseptal flap group (n = 30). Functional sinonasal outcomes were evaluated in both groups in terms of sinonasal outcome test (SNOT-22), crusting, adhesions, and olfaction.

Results: the sinonasal outcome test (SNOT-22), as well as the olfaction scores were significantly better in the double flap group compared to the rescue flap group. Crusting and adhesions occurred more frequently in the rescue flap group. The nasal stage operative time was significantly longer in the double flap group than the rescue flap group.

Conclusion: Endoscopic pituitary surgery can adversely affect the sinonasal functions. Double nasoseptal flap technique allows posterior septectomy with bilateral septal mucosa preservation. Although it requires longer operative time than the rescue flap technique, better functional sinonasal outcomes and olfaction scores are achieved.

Keywords: Nasoseptal flap; Outcomes; Pituitary adenoma; Rescue flap; Sinonasal; Trans-sphenoid.

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Conflict of interest statement

Declarations. Ethics approval: The study was approved by the Mansoura Faculty of Medicine Institutional Research Board (IRB: MD.22.11.721.R1). This randomized clinical trial was registered at ClinicalTrials.gov (NCT06526481). Informed consent: Informed consent was obtained from all individual participants included in the study. Conflict of interest: The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
The rescue flap technique. A: The horizontal incision on the nasal septum (the arrow). B: Elevation of the flap (F) downwards from the septal cartilage. C: Posterior septectomy is performed by removing the perpendicular plate of the ethmoid (P) and vomer without preservation of the contralateral mucosa. D: Exposure of the sphenoid rostrum (R) and ostia; RO: right ostium, LO: left ostium
Fig. 2
Fig. 2
The double nasoseptal flap group. A: Incisions of the flap; the superior incision (S) and the inferior incision (I) are connected anteriorly with an anterior vertical limb (A). B: Elevation of the flap (F) from the septal cartilage (C). C: Elevation of a contralateral smaller flap. D: Posterior septectomy is performed after elevation of the two flaps; P: perpendicular plate of the ethmoid bone
Fig. 3
Fig. 3
The consort flow chart of the study
See this image and copyright information in PMC

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