Mucosal Flaps in Frontal Sinus Surgery

Abstract

AbstractAfter creating a large area of bare bone left to heal spontaneously, osteitis acts as a source of inflammation causing mucosal edema, hypertrophy, scarring, stenosis, and ultimately, surgical failure. Frontal neo-ostium restenosis is the most significant cause of surgical failure in frontal sinus surgery. The only randomized control trial comparing frontal sinus drill-out grafts versus no reconstruction reported significantly bigger frontal neo-ostia 1 year after surgery, with numerous publications indicating that the use of free or pedicled grafts has led to better outcomes. Hence, grafts that can be free or pedicled are always highly recommended after every Draf III approach whenever possible. Free grafts can be harvested from the septal mucosa on both sides, the region where the septal window will be created. Pedicled flaps depending on the location of the flap base can be divided mainly into anteriorly based septal flap, septoturbinal mucosal flap, anterior pedicled flap, and superior lateral anterior pedicle flap. At the end of surgery, circumferential reconstruction of the frontal neo-ostium with a combination of grafts is used in order to leave as few gaps of exposed bone as possible. Grafts adhere to bare bone spontaneously and remain stable in position, with no need for fixation.KeywordsDraf IIIChronic sinusitisEndoscopic LothropEndoscopic frontal sinus surgeryFrontal sinusotomyMucosal graftsMucosal flaps