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What is the evidence for the use of mucosal flaps in Draf III procedures?

Wei, Calvin C.a; Sama, Anshulb

Current Opinion in Otolaryngology & Head and Neck Surgery: February 2014 - Volume 22 - Issue 1 - p 63–67
doi: 10.1097/MOO.0000000000000023
NOSE AND PARANASAL SINUSES: Edited by Samuel S. Becker and Nithin D. Adappa

Purpose of review Recent literature has described the use of mucosal grafts or transplants to reduce the rate of frontal ostium restenosis after the endoscopic-modified Lothrop procedure. This article presents a review of the literature on the rates of revision and restenosis related to Draf III procedures, factors implicated in the causation of restenosis and the evidence to support the role of mucosal grafts in reducing restenosis rates.

Recent findings Compared to historic data and to the meta-analysis data by Anderson and Sindwani, results from three case series examining the use of mucosal flaps after endoscopic-modified Lothrop procedure look extremely promising compared to a baseline average stenosis rate of 19% and revision rate of 14% quoted in the literature.

Summary Although the concept appears sound in principle and the limited series published show potential reduction in revision rates, there is inadequate evidence to state conclusively that this technique will improve the results of Draf III procedures in all surgical hands.

aDepartment of Otolaryngology-Head and Neck Surgery, St. Luke's-Roosevelt Hospital, New York, USA

bNottingham University Hospitals NHS Trust, Queens Medical Centre Campus, Nottingham, UK

Correspondence to Anshul Sama, FRCS, Nottingham University Hospitals NHS Trust, Queens Medical Centre Campus, Derby Road, Nottingham NG7 2UH, UK. Tel: +44 115 9249924 ext 65516; fax: +44 115 9709748

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