MINIMIZING UPPER LIP AND INCISOR TEETH PARESTHESIAS IN APPROACHES TO TRANSSPHENOIDAL SURGERY

Currently popular transsphenoidal approaches to the pituitary include sublabial, external rhinoplasty, alotomy, and transnasal techniques, T he conventional sublabial approach remains the workhorse method despit e postoperative lip edema, potential difficulty for denture wearers, a nd troublesome persistent upper lip and incisor teeth numbness. We tra ced the courses of the nasopalatine, infraorbital, and anterior superi or alveolar nerves in 41 cadaveric half-head dissections to determine the exact contribution to upper lip and incisor teeth innervation. We then conducted a retrospective patient survey of 25 sublabial, 28 exte rnal rhinoplasty, 23 alotomy, and 12 transnasal approaches to the hypo physis to assess the incidence of upper lip and incisor teeth paresthe sias lasting longer than 1 month. We conclude that rhinoplastic techni ques are superior to the sublabial approach in limiting upper lip and incisor teeth numbness without compromising neurosurgical exposure for hypophysectomy.