[Local flap reconstruction techniques after frontal sinus drainage type II and III according to Draf]

Area of Science:

• Otolaryngology, specifically endoscopic sinus surgery.
• Surgical techniques for managing complex frontal sinus disease.

Context:

• Extended endonasal endoscopic frontal sinus surgery (EFSS) involves bone resection beyond the frontal sinus lamellae, classified under Draf types IIa, IIb, modified III (IIc), and III.
• High restenosis rates (7-36%) are reported despite maximal openings, often attributed to slow epithelization and crusting of exposed bone.
• Mucosal coverage of exposed bone is recognized as a method to mitigate restenosis.

Purpose:

• To review and present various flap techniques for frontal sinus drainage in Draf III procedures.
• To evaluate the outcomes and achieved opening areas of contemporary Draf III surgeries.
• To establish best practices for extended frontal sinus surgery based on current evidence.

Summary:

• A variety of flap techniques, including free mucosal grafts, pedicled mucosal flaps, and hybrid approaches, are presented for Draf III frontal sinus surgery.
• Contemporary Draf III surgeries demonstrate significantly improved and larger opening areas compared to earlier methods.
• Studies consistently show markedly improved outcomes with mucosal coverage, highlighting its importance in reducing restenosis.

Impact:

• Mucosal coverage, particularly through flap techniques (free, pedicled, or combined), should be the standard for extended frontal sinus surgery (Draf IIb, IIc, III, EFSS 4-6).
• Proficiency in various flap techniques is crucial for surgeons to select the most suitable method based on individual patient anatomy and surgical extent.
• Improved surgical outcomes and reduced restenosis rates are anticipated with the consistent application of flap techniques.