Microscopic Endonasal Transsphenoidal Surgery in Patients with Small Nostril

Recently, the endonasal transsphenoidal approach has been widely used as the standard technique for pituitary surgery instead of the sublabial approach. However, using this approach involves potential conflicts between surgical instruments when entering the nostril and while working inside even with an endoscope. In patients with small nostril, it requires an additional tension release incision to acquire sufficient working space, especially for the procedure with the speculum because the anterior nasal spine and the medial edge of the maxillary bone crest mainly limit the speculum opening. For children whose nostrils are less than 10 mm in diameter, an additional incision made across the base of the columella allows the speculum to spread to about 20 mm. For adults, such as women and Asians whose nostrils are around 10 mm in diameter, the disarticulation of the septal cartilage on the nasal crest of maxilla without columellar incision allows the speculum to spread to about 15 mm.This report describes a simple technique with or without columellar incision using the microscopic endonasal transsphenoidal approach for patients with small nostril.