How to preserve the olfaction in harvesting the nasoseptal flap in endoscopic skull base surgery

The introduction of nasoseptal flap for the skull base defects reconstruction in endoscopic endonasal approaches represents a revolution that dramatically reduced incidence of the cerebrospinal fluid leaks, however it may be associated with comorbidities like olfactory hypofunction. Objectives: We revise our anatomical knowledge and surgical experience in order to describe an easy and safe technique to avoid olfaction hypofunction. Methods (Surgical technique): A simple anatomical surgical landmark proposed for identification of the olfactory area on the septum, based on the anatomy of the lateral nasal wall. More specifically, the level of the common axilla of the turbinates can be utilized to identify the distribution of the olfactory fibers on the nasal septum. Results: There was no significant change in the subjective olfaction identification score in the postoperative period. Conclusion: The common axilla line considered as a crucial landmark and an easy way to spare olfaction during harvesting the nasoseptal flap.