Nasal Floor and Inferior Septal Free Mucosal Graft, Anatomic Study, and Endoscopic Correlations in Fresh Cadaver

Anatomical study of the free mucosal graft from the nasal floor cavity for sellar reconstruction.

Objectives/Hypothesis: There is no study in the literature about the potential dimensions of this nasal cavity floor free mucosal graft and how to standardize its harvest to obtain an ideal sized graft to cover the sellar defect. A radiological study of the sellar defect was performed to compare with the graft measurements.

Methods: The graft was harvested in ten fresh cadavers (20 sides). A marking pen was used to draw a line along the transition between the nasal septum and the nasal floor, another line was drawn in the septal mucosa parallel to the first one at the level of the superior edge of the inferior turbinate (IT). A third parallel line was drawn at the level of the inferior border of the middle turbinate (MT). Then the IT was elevated to expose the meatus. A lateral incision was performed along the attachment of the IT from its tail to the head. The posterior incision was made along the nasal cavity floor from the tail of the IT toward the septum between the soft and hard palate. The septal mucosa was also included up to the inferior border of MT. The septal incision was carried from posterior to anterior, parallel to the MT, until the level of the head of the IT. The anterior cut was performed joining the septal and the lateral incisions. A radiological study was done with 15 MRIs of patients with macroadenomas (larger diameter: 3.2–5.1 cm, median: 3.7 cm). Two measurements were done to estimate the size of the defect: sagittal plane—distance from the tuberculum sellar to the sellar floor (TS-SF); coronal plane—distance between the cavernous ICAs (ICA-ICA).

Results: The radiological measurements showed the estimate TS-SF defect size of 1.9 cm (1.6–2.6) and ICA-ICA of 2.1 cm (1.5–3). The cadaveric measures showed the mean anterior-posterior (AP) graft length was 3.4 cm (3.1–4.3) and would cover all estimated dimensions of the sellar defect. The mean lateromedial (LM) length from the IT attachment to septum was 1.7 cm (1.1–2.3), the mean LM length from the IT attachment to the septum at the level of the superior border of the IT was 2.7 cm (2.1–3.5). The maximum LM dimension, which was measured from the IT attachment to the septum at the level of the inferior border of the MT was 3.8 cm (3.2–5). Regarding LM dimension, only the maximum dimension from the IT attachment to the septum at the level of the inferior border of the MT would cover all estimated size defects. The smallest graft measured from the IF attachment of the septum at the level of the superior border of the IT would cover 60% of the defects.

Conclusion: The free mucosal graft harvested from the IT attachment along the nasal floor including the septal mucosa up to the level of the inferior border of the MT would cover all defects resultants from resection of large pituitary macroadenomas (>3.2 cm).

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No conflict of interest has been declared by the author(s).