Mini-nasoseptal flap for recalcitrant sphenoid sinusitis

Persistent sphenoid sinusitis remains a clinical challenge despite multiple surgical interventions. Standard endoscopic approaches often fail in patients with extensive inflammation or prior surgeries. Scar formation at the sphenoid ostium is a known contributor to recurrence. While various surgical techniques exist, none specifically address scarring after wide sphenoid sinusotomy. Prior research has shown that fungal sinusitis and mucoceles increase the risk of restenosis. The need for a targeted solution to prevent cicatricial narrowing has not been fully met. This gap motivated the development of a novel flap technique. That uncertainty drove the exploration of flap-based strategies to isolate healing tissue from the ostium.

This study aimed to evaluate a modified nasoseptal flap for preventing sphenoid ostium restenosis. The specific problem was persistent inflammation and scarring after revision sinus surgery. The motivation was to provide a new surgical option for patients with complex sinus pathology. The flap was designed to cover exposed bone after wide sinusotomy. The goal was to reduce scar formation and improve healing outcomes. The study focused on patients with a high risk of recurrence. The approach was tested in a case series of patients with fungal sinusitis. The outcome of interest was restenosis prevention over time.

A case series was conducted using a modified nasoseptal flap technique. Patients with inflammatory sphenoid sinus conditions were selected. The flap was used to cover exposed bone after sphenoid sinusotomy. Flap harvest and inset were performed during endoscopic surgery. Postoperative follow-up ranged from 2 to 21 months. Nine patients were included in the study cohort. The flap was applied in cases with fungal sinusitis or mucoceles. No major complications were observed related to flap use.

The mini-nasoseptal flap successfully prevented restenosis in all nine patients. Mean follow-up was 8.4 months with no recurrence reported. Patients had a mean of 2.3 prior sinus surgeries. Six patients had fungal sinusitis or fungal balls. Six patients had sphenoid wall osteoneogenesis. No significant side effects were observed from flap harvest. The flap reduced cicatricial scarring around the ostium. The technique offers a new option for complex sphenoid cases.

The mini-nasoseptal flap decreases restenosis risk after sphenoid sinusotomy. The flap prevents circumferential scarring at the ostium. The authors suggest this technique is effective in select patients. The study supports the use of flaps in inflammatory sinus conditions. The flap offers an alternative to standard revision techniques. The authors propose further study in larger patient groups. The method may be particularly useful after fungal sinusitis. The findings suggest a role for flap use in complex revision cases.