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Free mucosal grafts and anterior pedicled flaps to prevent ostium restenosis after endoscopic modified Lothrop (frontal drillout) procedure: a randomized, controlled study
Author(s) -
Wang YingPiao,
Shen PingHung,
Hsieh LiChun,
Wormald PeterJohn
Publication year - 2019
Publication title -
international forum of allergy and rhinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.503
H-Index - 46
eISSN - 2042-6984
pISSN - 2042-6976
DOI - 10.1002/alr.22416
Subject(s) - medicine , ostium , surgery , frontal sinus , restenosis , stenosis , visual analogue scale , radiology , stent
Background The endoscopic modified Lothrop procedure (EMLP) is used to manage ongoing refractory frontal sinusitis after failed previous endoscopic sinus surgery (ESS), but this approach has a significant restenosis rate. We evaluated the potential benefits of mucosal grafts and pedicled flaps on the opening of the newly formed frontal ostium. Methods Fifty patients with refractory frontal sinusitis or mucoceles after ESS were randomized to undergo EMLP, either with (n = 27) or without (n = 23) mucosal grafts and pedicled flap reconstruction of the neo‐ostium. The frontal neo‐ostium was measured with Lindholm distending forceps, and anteroposterior (A‐P) and lateral dimensions were measured intraoperatively, and then again at 6 weeks, 6 months, and 12 months postoperatively. Olfaction outcomes were assessed using the Taiwan Smell Identification Test (TWSIT) and a smell visual analog scale (VAS) score preoperatively and at 6 months postsurgery. Results The initial intraoperative mean lateral and A‐P dimensions were 23.2 ± 2.7 mm and 14.8 ± 2.3 mm and were significantly decreased at all time‐points postoperatively. The mucosal grafts and pedicled flaps had greater lateral and A‐P dimensions, and a greater percentage of intraoperative frontal neo‐ostium area at all time‐points postoperatively (all p < 0.05). At 6 months postoperatively, TWSIT ( p = 0.027), but not the smell VAS score ( p = 0.063), was significantly improved compared with baseline. TWSIT and smell VAS score changes did not differ between groups ( p = 0.92 and p = 0.85, respectively). Conclusion The use of mucosal grafts and pedicled flaps reduces stenosis of the frontal neo‐ostium postsurgery and should be considered after EMLP.