Dental considerations in the sublabial trans-sphenoidal surgical approach to the pituitary gland

The sublabial trans-sphenoidal approach for the ablation of pituitary tumors can cause denervation or pulp death of some of the anterior teeth. The problem results from the bone removal necessary for placement of the nasal retractor. When bone is removed close to the apices of the anterior teeth, root injury may occur. This complication may be avoided through preoperative evaluation of skeletal and dental morphology. This evaluation reveals the amount of bone between the tooth roots and the nasal floor and hence the ultimate access for the nasal retractor.