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Chapter-014 Transsphenoidal Approaches to the Sella Turcica

BOOK TITLE: Head & Neck Surgery (2 Volumes)

Author
1. Neal Jeffrey G
2. Osguthorpe J David
3. Schlosser Rodney J
ISBN
9788184486797
DOI
10.5005/jp/books/10351_14
Edition
1/e
Publishing Year
2009
Pages
7
Author Affiliations
3. Medical University of South Carolina Charleston, South Carolina, USA, Medical University of South Carolina, Charleston, South Carolina, USA
Chapter keywords
transsphenoidal approaches, sella turcica, hemitransfixion, Killian incision, nostril, septal translocation, cottonoid pledgets, Oxymetazoline, pituitary tumor, gingivolabial sulcus, ethmoid

Abstract

This chapter discusses transsphenoidal approaches to the sella turcica, where a hemitransfixion or Killian incision is made in the nostril and the entire procedure is performed through one nostril, which with concomitant septal translocation usually allows the insertion of the regular transsphenoidal retractor. Oxymetazoline or 5% cocaine soaked cottonoid pledgets are initially used to pack the nostrils, using a nasal speculum, bayonet foreceps, and a headlight. The vomer and perpendicular plate of the ethmoid are visualized once the retractor is in place, and much is removed with a Takahashi or similar instrument as submucosal dissection proceeds up to the face of the sphenoid sinus in the midline. Fluoroscopy may be used to determine the relationship of the transsphenoidal retractor to bony landmarks and to aid in determining the pathway of surgical approach to the pituitary tumor. The transnasal transsphenoidal approach to pituitary tumors proceeds in the same fashion as the sublabial approach except that no incision is made along the gingivolabial sulcus.

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