title: Nasoseptal flap reconstruction of pediatric sellar defects: a radiographic feasibility study and case series.
abstract: OBJECTIVE
  In this study, we used computed tomography measurements to investigate the feasibility of nasoseptal flap reconstruction of sellar defects in children, and we reviewed our institutional experience with the procedure.
  
  
  METHODS
  Cross-sectional and case series.
  
  
  METHODS
  Pediatric tertiary care facility.
  
  
  METHODS
  We obtained 10 normal maxillofacial scans for each year of age from birth to 18. Computer-assisted nasal and skull-base measurements were performed. Patients with incomplete pneumatization were excluded from analysis. Reconstruction was presumed feasible if the ratio of nasoseptal flap length to associated sellar defect length was greater than 1. Chart review identified surgical patients.
  
  
  RESULTS
  Of 190 scans, 125 had complete pneumatization. Of these, 120 (96%) displayed a ratio of nasoseptal flap length to sellar defect length greater than 1, suggesting that reconstruction would be feasible. Mean ratio of flap length to defect length for all subjects was 1.47 (SD 0.33; 95% CI, 1.41-1.53). Only 5 of 125 patients (4%) had a ratio less than 1; the median age for these patients was 15 years, which is older than the median age of 12 years for subjects with a ratio greater than 1 (P = .02). An inverse relationship was identified between age and ratio of flap length to defect length (r = -0.49, P < .001). Case series identified 6 children, ages 5 to 17; flap length was never described as a limitation.
  
  
  CONCLUSIONS
  Nasoseptal flap length is not a limiting factor for reconstruction of pediatric sellar defects. When compared with older patients, younger patients tend to have greater nasoseptal flap length relative to sellar defect length.
authors.affiliation: Department of Otolaryngology, University of Washington, Seattle, Washington, USA plpurcel@uw.edu.
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Purcell
authors.affiliation: Department of Otolaryngology, University of Washington, Seattle, Washington, USA.
authors.forename: Justin R
authors.initials: JR
authors.lastname: Shinn
authors.affiliation: Department of Radiology, Seattle Children's Hospital, Seattle, Washington, USA.
authors.forename: Randolph K
authors.initials: RK
authors.lastname: Otto
authors.affiliation: Department of Otolaryngology, University of Washington, Seattle, Washington, USA.
authors.forename: Greg E
authors.initials: GE
authors.lastname: Davis
authors.affiliation: Department of Otolaryngology, University of Washington, Seattle, Washington, USA Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA.
authors.forename: Sanjay R
authors.initials: SR
authors.lastname: Parikh
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003397:Craniopharyngioma / Q000601:surgery*; D003430:Cross-Sectional Studies; D004724:Endoscopy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D010911:Pituitary Neoplasms / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012658:Sella Turcica; D019291:Skull Base / Q000000981:diagnostic imaging / Q000601:surgery; D019292:Skull Base Neoplasms / Q000601:surgery; D013524:Surgical Flaps; D014057:Tomography, X-Ray Computed
keywords: computed tomography; endoscopic surgical procedure; nasoseptal flap; pediatric surgery; skull base surgery