title: Mini-nasoseptal flap for recalcitrant sphenoid sinusitis.
abstract: BACKGROUND
  Recalcitrant sphenoid sinusitis occurs in 27% of patients undergoing revision functional endoscopic sinus surgery. One of the main causes of disease recurrence in the sphenoid is cicatricial scarring of the ostium. Highly inflammatory lesions such as fungal balls or chronic mucoceles can predispose patients to restenosis. We present a novel use of a modified nasoseptal flap to cover exposed bone after sphenoid wide sinusotomy to prevent restenosis and expedite healing.
  
  
  METHODS
  A case series was performed.
  
  
  RESULTS
  The mini-nasoseptal flap was successful in preventing sphenoid ostium restenosis in nine patients undergoing endoscopic sinus surgery for highly inflammatory sphenoid sinus pathology with a mean postoperative follow-up of 8.4 months (range, 2-21 months). Patients had a mean of 2.3 prior sinus surgeries (range, 0-7 surgeries). Most common indications for the flap in this series included long-standing fungal sinusitis or fungal balls (n = 6) with or without significant sphenoid wall osteoneogenesis (n = 6). There were no significant side effects related to flap harvest or inset.
  
  
  CONCLUSIONS
  The mini-nasoseptal flap decreases the risk of restenosis after sphenoid sinusotomy by preventing circumferential cicatricial scarring and offers an effective surgical option on the spectrum of sphenoid surgical interventions in select patients.
authors.affiliation: Department of Head and Neck Surgery, University of California, Los Angeles, California 90095-1624, USA. chrthompson@mednet.ucla.edu
authors.forename: Christopher F
authors.initials: CF
authors.lastname: Thompson
authors.forename: Adam S
authors.initials: AS
authors.lastname: DeConde
authors.forename: Alexander G
authors.initials: AG
authors.lastname: Chiu
authors.forename: John M
authors.initials: JM
authors.lastname: Lee
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Suh
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D002921:Cicatrix / Q000209:etiology / Q000517:prevention & control; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009181:Mycoses / Q000150:complications / Q000601:surgery*; D009300:Nasal Septum / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control; D019651:Plastic Surgery Procedures / Q000379:methods*; D055502:Secondary Prevention; D013100:Sphenoid Bone / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D015524:Sphenoid Sinusitis / Q000209:etiology / Q000601:surgery*; D013524:Surgical Flaps