lex frontal sinus disease called Draf IIB frontal sinusotomy. Although the excellent results in terms
of frontal sinus drainage have been reported with this technique, postoperative stenosis and neo-ostium
restenosis are still considerable problems. Mucosal preservation techniques, in addition to the use of
vascularized mucosal flaps, have been utilized to enhance healing and maintain patency of the frontal
sinuses. Aim: We review the existing evidence regarding the role of mucosal flap techniques to optimize
outcomes following Draf IIB frontal sinusotomy. Methods: A narrative review of the literature on studies
reporting mucosal conservation and flap reconstruction in endoscopic frontal sinus surgery specifically
in Draf IIB techniques was performed. We reviewed articles focusing on surgical procedures,
postoperative outcomes and complications. Results: Various mucosal flap techniques created to enhance
mucosal coverage of uncovered bone, minimize postoperative scarring. Types of flaps that are frequently
described include: septal mucosal flap; middle turbinate–based flaps; and lateral nasal wall flaps. These
techniques aim to facilitate mucosal healing, minimize granulation tissue development and lower the risk
of restenosis at the frontal sinus ostium. Multiple studies suggest higher frontal sinus patency rates and
improved postoperative healing when mucosal flaps are used. Conclusions: Mucosal flaps are a
significant adjunct in the Draf type IIB frontal sinusotomy. Optimal results in endoscopic frontal sinus
surgery can be attributed to mucosal preservation and careful flap selection.