Newly Designed Double Vascularized Nasoseptal Flaps to Prevent Restenosis after Modified Endoscopic Lothrop Procedure (DRAF III)

Introduction: Despite advances in endoscopic approaches, the management of frontal sinus is still challenging. Failure of the endoscopic procedure and restenosis of the new-formed ostium have been demonstrated even with large frontal sinosotomy. We describe a newly designed double nasoseptal flap to cover the bare bone after EMLP. Methods: Five fresh, double injected cadavers were dissected through an endoscopic endonasal approach. Posterior-based nasoseptal flap in one side and lateral-based nasoseptal flap on the other side were harvested before performing a wide EMLP. Feasibility of the procedure, versatility of the flap, coverage area, and measurements were calculated. Clinical applications on our patients were evaluated along with follow-up of 9 months. Results: Harvesting the mucoperiosteal flap over the septectomy site was a straightforward step. Two different designed flaps (one on each side) are more practical to avoid torsion of the flap. The flap measures 2×3 cm on average that was able to cover the bare bone of the anterior and posterior wall of frontal sinus. Clinically, our patients are symptomatic and have patent frontal sinus. Conclusion: Osteoneogenesis and progressive osteoplastic activity after EMLP plays a major role in restenosis of frontal sinus. Vascularized nasoseptal flap helps in preventing closure of the new-formed ostium. Applying these flaps over the bare bone enhances the healing process and minimizes the crust formation.