Objectives The aim of this study was to determine the clinical characteristics and cephalometric risk factors associated with decreased postoperative olfaction in patients in whom the transplanum and transtuberculum expanded endonasal approach (EEA) was performed.

Methods A retrospective cohort of 41 patients treated with the transplanum and transtuberculum EEA was divided into two groups based on the maximum change in the postoperative 22-item Sino-Nasal Outcome Test (SNOT22) olfaction score: prolonged olfactory loss group (n = 5) with a ΔSNOT22 olfaction score of ≥ 4 without a return to baseline and a preserved olfaction group (n = 36) with a ΔSNOT22 olfaction score ≤ 3 with return to baseline on follow-up of at least 3 months. Demographics, operative details, and cephalometric measurements were compared between the two groups.

Results There were no differences in terms of the type of surgical approach (transplanum and transtuberculum), resection of turbinates (middle and superior), use of reconstructive flap (nasoseptal flap and reverse flap), or tumor pathology between the two groups. In the prolonged olfactory loss group, there was a smaller angle between the planum and the face of the sella (89.75 ± 9.18 vs. 107.17 ± 16.57 degrees, p = 0.05) and a smaller angle between the anterior nasal spine and the sphenoid sinus face (21.20 ± 2.49 vs. 25.89 ± 4.90 degrees, p = 0.047) compared with the preserved olfaction group.

Conclusions Patients with a narrow angle between the planum and the face of the sella or that between the anterior nasal spine and the sphenoid sinus face are at a higher risk of prolonged olfactory dysfunction with the transplanum and transtuberculum approaches.

Level of Evidence IV.

目的 本研究的目的是确定接受经皮和经结节扩大鼻内入路 (EEA) 的患者的临床特征和与术后嗅觉下降相关的头影测量危险因素。

方法 回顾性队列 41 例接受经皮和经结节 EEA 治疗的患者，根据术后 22 项鼻鼻结果测试（SNOT22）嗅觉评分最大变化：嗅觉丧失延长组分为两组（ n = 5  ） ΔSNOT22 嗅觉评分 ≥ 4 且未恢复至基线，嗅觉保留组 ( n  = 36) ΔSNOT22 嗅觉评分 ≤ 3，并在至少 3 个月的随访中恢复至基线。比较两组之间的人口统计学、手术细节和头影测量。

结果 两组在手术入路类型（经鼻甲和经结节）、鼻甲切除（中、上）、重建皮瓣（鼻中隔皮瓣和反向皮瓣）的使用或肿瘤病理方面没有差异。在长期嗅觉丧失组中，平面和鞍面之间的角度较小（89.75 ± 9.18 vs. 107.17 ± 16.57 度，p  = 0.05），前鼻棘和蝶窦面之间的角度较小(21.20 ± 2.49 vs. 25.89 ± 4.90 度，p  = 0.047) 与保留嗅觉组相比。

结论 平面与蝶鞍面之间或前鼻棘与蝶窦面之间夹角较窄的患者，采用经平面和经结节入路时出现长期嗅觉功能障碍的风险较高。

证据级别 IV。