Value of double pedicled mucoperiosteal flaps for the prevention of restenosis in Draf IIb frontal sinusotomy.

Introduction: The extent of bone exposure is one of the major factors contributing to failure of endoscopic frontal sinusotomy procedures. Double flaps providing cover of exposed bone have already been described for Draf III procedures in a cadavre study using posterior and lateral pedicled nasoseptal flaps. As these flaps overlap on the septal side, they cannot be raised from the same nasal cavity in a Draf IIb procedure. We describe a new technique using 2 local mucoperiosteal flaps raised from the same side to entirely cover the bone margins exposed by Draf IIb frontal sinusotomy.

Surgical Technique: A left Draf IIb procedure was performed to drain a frontal mucocele. A posterior septoturbinal flap (PSTF) was raised to cover the posterior sinusotomy margin. A lateral pedicle nasoseptal flap (LNSF) was raised on the same side to cover the anterior margin. With a follow-up of 6 months, the Draf IIb cavity was fully patent and the flaps were well integrated.

Conclusion: PSTF and LNSF flaps can be raised on the same side to cover the posterior and anterior margins of the Draf IIb frontal sinusotomy, respectively.