Nasal and Sublabial Approaches to the Pituitary Workup

  • Author: Howard S Kotler, MD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Apr 13, 2012
 

Imaging Studies

  • The preoperative workup for patients undergoing transphenoidal resection of the pituitary includes a thorough history of sinus disease (eg, hyposmia, epistaxis, nasal polyps, nasal discharge, sinusitis) and past nasal and sinus surgical treatment. Active or untreated chronic sphenoid sinusitis is a contraindication to performing the transphenoidal approach to the pituitary.
  • A CT scan is indispensable prior to performing any sinus surgery, and the transnasal-sublabial approach to the sphenoid sinus is no exception. Perform preoperative noncontrast-enhanced CT scanning in both the axial and the coronal planes. These positions allow the surgeon to visualize essential sinus anatomic relationships. The relationship of the perpendicular plate of the ethmoid bone to the sphenoid rostrum and the presence and location of any intersinus septae are important anatomic considerations. The CT scan also gives indication of any nasal or intrasinus pathology that may require surgical or medical treatment prior to transphenoidal hypophysectomy. Critical anatomic variations in the carotid artery or optic nerve can also be observed from the CT scan.
  • MRI can help differentiate infectious etiology from mucocele formation in the sinus. MRI studies may also help differentiate a possible vascular mass from the projection of 1 or both carotid arteries into the sinus.

Coronal and median sagittal images are shown in the image below.

Coronal and median sagittal images of pituitary adCoronal and median sagittal images of pituitary adenoma.
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Contributor Information and Disclosures
Author

Howard S Kotler, MD  Clinical Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, University of Illinois at Chicago

Howard S Kotler, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate/Craniofacial Association, American College of Physician Executives, American Medical Association, American Medical Informatics Association, Chicago Medical Society, and Illinois State Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Eric J Moore, MD, FACS  Residency Director, Associate Professor, Department of Otorhinolaryngology/Head and Neck Surgery, Mayo Graduate School of Medicine

Eric J Moore, MD, FACS is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate/Craniofacial Association, and American Head and Neck Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Karen H Calhoun, MD, FACS, FAAOA  Professor, Department of Otolaryngology-Head and Neck Surgery, Ohio State University College of Medicine

Karen H Calhoun, MD, FACS, FAAOA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Head and Neck Society, American Medical Association, American Rhinologic Society, Association for Research in Otolaryngology, Society of University Otolaryngologists-Head and Neck Surgeons, Southern Medical Association, Texas Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Christopher L Slack, MD  Private Practice in Otolaryngology and Facial Plastic Surgery, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Medvoy Ownership interest Management position; Cerescan Imaging Consulting; Headwatersmb Consulting fee Consulting; Venturequest Royalty Consulting

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Coronal and median sagittal images of pituitary adenoma.
Normal median sagittal nasal anatomy.
Normal coronal nasal anatomy.
Elevation of septal mucoperichondrial-periosteal flap.
Coronal view of septal mucoperichondrial flap elevation.
Elevation of discontinuous septal mucoperichondrial and nasal floor mucoperiosteal flaps.
Continuous septal mucoperiosteal and nasal floor mucoperiosteal flaps.
Continuous septal and nasal flaps and contralateral nasal floor flap.
Transection of septal cartilage, vomer, and ethmoid bones.
Gingivolabial incision.
Insertion of speculum through gingivolabial incision.
Placement of speculum after removal of septal cartilage and bone.
Incision through nasal floor.
Medialization of nasal floor flap.
 
 
 
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