Lacrimal sac exposure and a superior lateral anterior pedicle flap to improve outcomes of Draf type II and III procedures

Omura, Kazuhiro; Nomura, Kazuhiro; Aoki, Satoshi; Katori, Yukio; Tanaka, Yasuhiro; Otori, Nobuyoshi

doi:10.1002/alr.22122

Cited by 23 publications

(32 citation statements)

References 15 publications

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“…Omura et al designed a surgical technique exposing the lacrimal sac and using a superior lateral anterior pedicle flap to cover the exposed bone during the Draf II and III procedures in a series of 19 patients . Overall, the neo‐ostium remained patent in all patients for at least 6 months after these procedures.…”

Section: Discussionmentioning

confidence: 99%

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Free mucosal grafts and anterior pedicled flaps to prevent ostium restenosis after endoscopic modified Lothrop (frontal drillout) procedure: a randomized, controlled study

Wang

Shen

Hsieh

et al. 2019

Int Forum Allergy Rhinol

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Background:The endoscopic modified Lothrop procedure (EMLP) is used to manage ongoing refractory frontal sinusitis a er failed previous endoscopic sinus surgery (ESS), but this approach has a significant restenosis rate. We evaluated the potential benefits of mucosal gra s and pedicled flaps on the opening of the newly formed frontal ostium. Methods:Fi y patients with refractory frontal sinusitis or mucoceles a er ESS were randomized to undergo EMLP, either with (n = 27) or without (n = 23) mucosal gra s and pedicled flap reconstruction of the neo-ostium. The frontal neo-ostium was measured with Lindholm distending forceps, and anteroposterior (A-P) and lateral dimensions were measured intraoperatively, and then again at 6 weeks, 6 months, and 12 months postoperatively. Olfaction outcomes were assessed using the Taiwan Smell Identification Test (TWSIT) and a smell visual analog scale (VAS) score preoperatively and at 6 months postsurgery. Results:The initial intraoperative mean lateral and A-P dimensions were 23.2 ± 2.7 mm and 14.8 ± 2.3 mm and were significantly decreased at all time-points postoperatively. The mucosal gra s and pedicled flaps had greater lateral and A-P dimensions, and a greater percentage of intraoperative frontal neo-ostium area at all time-points postoperatively (all p < 0.05). At 6 months postoperatively, TWSIT (p = 0.027), but not the smell VAS score (p = 0.063), was significantly improved compared with baseline. TWSIT and smell VAS score changes did not differ between groups (p = 0.92 and p = 0.85, respectively). Conclusion:The use of mucosal gra s and pedicled flaps reduces stenosis of the frontal neo-ostium postsurgery and should be considered a er EMLP. C 2019 ARS-AAOA, LLC.

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Section: Discussionmentioning

confidence: 99%

“…Recent studies described the use of mucosal grafts or pedicle flaps to decrease frontal neo‐ostium restenosis, and the results indicate that the use of these grafts or flaps led to excellent outcomes . However, no comparative studies have been reported.…”

mentioning

confidence: 99%

Free mucosal grafts and anterior pedicled flaps to prevent ostium restenosis after endoscopic modified Lothrop (frontal drillout) procedure: a randomized, controlled study

Wang

Shen

Hsieh

et al. 2019

Int Forum Allergy Rhinol

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“…After skeletonizing the skull base and orbit, bilateral superior, and lateral anteriorly-pedicled mucosal flaps were elevated from the frontal process of the maxilla using a Beaver blade and Rosen round knife with integrated suction. 1 The bone over the lacrimal sac was then resected with a 2 mm otologic drill and 1 mm Kerrison rongeur until the lacrimal sac was exposed to maximize the working corridor laterally. The initial steps of an outside-in endoscopic modified Lothrop procedure were then initiated to expose the dermoid cyst.…”

Section: Surgical Techniquementioning

confidence: 99%

“…Pediatric endoscopic sinus and skull base surgery is challenging due to narrow anatomical confines, variable pneumatization of the paranasal sinuses, inter‐carotid distance, and limited instrumentation. However, with the refinement of endoscopic surgical techniques, and the development of new instruments in otolaryngology, the specific challenges of pediatric skull base surgery may be overcome with the adaptation of these techniques, and the adoption of new instruments 1,2 . The objective of this article is to present a novel technique using endoscopic ear instrumentation and a modified Draf III approach for the resection of a nasal dermoid cyst with an intracranial component that is applicable to the pediatric patient without frontal sinus pneumatization, and with narrow nasal cavities.…”

Section: Introductionmentioning

confidence: 99%

A Modified Endoscopic Draf III Approach in the Non‐Pneumatized Frontal Bone for Dermoid Cysts

2022

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“…To speed up mucosal healing and prevent osteitis, mucosa flaps can be used to cover exposed bone [15]. Several mucosal flaps applied to Draf procedures were reported varied from free grafts to pedicled flaps [2,5,11,[16][17][18][19][20]. A free graft is easy to manipulate but is lacking in viability.…”

Section: Introductionmentioning

confidence: 99%

Value of a lateral inferior pedicle flap in Draf IIb for recurrent frontal sinus diseases: a prospective study

Zhen

2022

Eur Arch Otorhinolaryngol

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Purpose The Draf IIb procedure allows the widest unilateral access to the frontal sinus in a minimally invasive fashion, with efficiency and safety comparable to the Draf III. However, this technique is still associated with a high postoperative stenosis rate. The exposure of drilled bone induces osteitis predisposing to scarring and neo-osteogenesis causing ostium restenosis. We developed a novel lateral inferior pedicle flap (LIPF) to cover the exposed bone and prevent restenosis during Draf IIb. We aimed to describe our technique. Methods Adult patients requiring a Draf IIb for unilateral recurrent frontal sinus disease were prospectively enrolled. A LIPF technique was systematically performed. Demographics and complications were recorded. The primary outcome measure was neo-ostium patency at 12 months. In patients with chronic rhinosinusitis (CRS), the clinical control rate was evaluated at 12 months. Results 59 patients underwent the Draf IIb with LIPF technique from 2013 to 2021. 49 patients (20 women/29 men, median age of 48.0 years) completed at least 12 months of follow-up (median 41.0 months, range 12–100 months). Indications included recalcitrant CRS (n = 32), inverted papilloma (n = 9) and frontal mucocele (n = 8). Overall, the neo-ostium remained patent at 12 months in all patients, and the clinical control rate of 32 patients with recalcitrant CRS at 12 months was 100%. No main complications were recorded. Conclusion The LIPF technique was associated with a high rate of success for a Draf IIb.

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Lacrimal sac exposure and a superior lateral anterior pedicle flap to improve outcomes of Draf type II and III procedures

Abstract: Draf type II and III procedures with lacrimal sac exposure and a superior lateral anterior pedicle flap are convenient and seem to be effective. However, further studies with larger numbers of patients are needed to verify our technique.

Cited by 23 publications

References 15 publications

Free mucosal grafts and anterior pedicled flaps to prevent ostium restenosis after endoscopic modified Lothrop (frontal drillout) procedure: a randomized, controlled study

Free mucosal grafts and anterior pedicled flaps to prevent ostium restenosis after endoscopic modified Lothrop (frontal drillout) procedure: a randomized, controlled study

A Modified Endoscopic Draf III Approach in the Non‐Pneumatized Frontal Bone for Dermoid Cysts

Value of a lateral inferior pedicle flap in Draf IIb for recurrent frontal sinus diseases: a prospective study

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