Preserving olfactory function in anterior craniofacial surgery through cribriform plate osteotomy applied in selected patients.
OBJECTIVE
Olfaction is often sacrificed to gain access to the cranial base in anterior craniofacial surgery. We describe the long-term results of olfactory function in patients who underwent anterior craniofacial surgery and a cribriform plate osteotomy to preserve olfaction.


METHODS
Between 1992 and 2004, 28 patients underwent 29 cribriform plate osteotomies in an attempt to preserve olfaction during anterior craniofacial surgery performed through modified extended transbasal approaches. Patients' charts and office notes were reviewed retrospectively. Formal olfactory testing was available in 5 patients, but most data were based on patients' subjective reports of olfaction. Olfactory preservation was defined by the subjective ability to detect fumes such as coffee, chocolate, roses, and orange juice regardless of the intensity of the sensation. Follow-up was based on phone calls to patients.


RESULTS
Four patients were lost to follow-up and excluded. Therefore, follow-up was available in 24 patients after 25 procedures. On the basis of patients' subjective reports, olfaction was spared in 22 patients after 23 procedures (92%) and was confirmed objectively in the five patients formally tested. After surgery, only two patients were anosmic.


CONCLUSIONS
Olfaction can be preserved in selected patients undergoing anterior craniofacial surgery. At least 1 cm of nasal mucosa should remain attached to the cribriform plate, which can be achieved by including the nasal bone in the osteotomy of the orbital bar. A medial orbital canthopexy is therefore necessary after these procedures.
Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Iman
I
Feiz-Erfan
Patrick P
PP
Han
Robert F
RF
Spetzler
Eric M
EM
Horn
Jeffrey D
JD
Klopfenstein
Louis J
LJ
Kim
Randall W
RW
Porter
Stephen P
SP
Beals
Salvatore C
SC
Lettieri
Edward F
EF
Joganic
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D020209:Cranial Nerve Injuries / Q000517:prevention & control*; D005004:Ethmoid Bone / Q000601:surgery*; D005147:Facial Bones / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000601:surgery*; D000857:Olfaction Disorders / Q000209:etiology / Q000517:prevention & control*; D009832:Olfactory Nerve / Q000601:surgery; D061219:Olfactory Nerve Injuries; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods*; D012888:Skull Neoplasms / Q000601:surgery; D016896:Treatment Outcome