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

Abstract

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.

Comprehensive access strategies to the frontal sinus

“…[22 ▪▪ ] To overcome this major complication, most authors recommend achieving the maximal opening of the neo-ostium (approximately 21.0 mm × 19.5 mm), regular debridement of the sinusotomy as an in-office procedure as far as the compete mucosal healing of the surgical cavity, consistent intranasal steroid delivery and, most importantly, minimize the area of uncovered drilled bone by using specifically designed mucoperiosteal flaps to resurface the surgical areas. [23,24 ▪ ,25,26]. Even though no statistically significant conclusion could be made according to a recent systematic review on this topic, patency rates after Draf type II and III surgery appear to be higher when flaps or grafts are applied (93.5%) versus when they were not (86.7%) [21].…”

Lateral pedicled nasoseptal flaps for bilateral frontal sinus inverted papillomas after endoscopic Draf III procedure

“…and He et al. introduced a lateral superior and inferior pedicle flap, respectively, in the Draf IIb/Draf III procedure 6,7 . Multiple flaps for bare bone both anteriorly and posteriorly were also introduced.…”