{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T13:02:48Z","timestamp":1791810168397,"version":"4.3.4"},"reference-count":41,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T00:00:00Z","timestamp":1754265600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T00:00:00Z","timestamp":1754265600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the impact of mucosal grafts and flaps on neo\u2010ostium patency and clinical outcomes in patients undergoing Draf IIb or III frontal sinus drill\u2010out procedures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources<\/jats:title>\n                    <jats:p>A systematic search was conducted across PubMed, Medline, Cochrane Library, Scopus, and Web of Science databases in accordance with Preferred Reporting Items for Systematic Reviews and Meta\u2010analyses (PRISMA) guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Review Methods<\/jats:title>\n                    <jats:p>Following PRISMA guidelines, consecutive studies were included, and a meta\u2010analysis was performed. Study characteristics, patient demographics, surgical outcomes, and neo\u2010ostium patency rates were extracted. Pooled relative risks (RRs) and mean differences (MDs) were estimated using random\u2010effects models. Publication bias was evaluated via funnel plots and Egger's test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Nine studies with 375 patients undergoing mucosal reconstruction were included, following 116 (30.9%) Draf IIb and 259 (69.1%) Draf III procedures. Four comparative studies were eligible for meta\u2010analysis. Draf III was performed in 97.2% of cases (n\u2009=\u2009318), with 165 (51.9%) patients in the flap group and 153 (48.1%) in the no\u2010flap group. Mean follow\u2010up was 41.3\u2009\u00b1\u20099.5 months. Mucosal flaps\/grafts significantly improved neo\u2010ostium patency (RR 1.087, 95% CI: 1.018\u20101.159,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.011) and reduced loss of neo\u2010ostium area (MD 19.52%, 95% CI: 9.97\u201029.06,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u2009.01). Clinical outcomes, including polyp scores and patient\u2010reported measures, showed high heterogeneity, limiting synthesis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Mucosal reconstruction may enhance neo\u2010ostium patency but could only be analyzed for Draf III. Variability in study design and outcome reporting remains a limitation. Standardized methodologies are essential to accurately assess the role of mucosal grafting in frontal sinus surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ohn.1374","type":"journal-article","created":{"date-parts":[[2025,8,5]],"date-time":"2025-08-05T06:20:41Z","timestamp":1754374841000},"page":"1079-1091","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Mucosal Grafts and Flaps in Draf IIb and Draf III: A Systematic Review and Meta\u2010analysis"],"prefix":"10.1002","volume":"173","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9912-9837","authenticated-orcid":false,"given":"Alexander","family":"Lein","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery Medical University of Vienna Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David T.","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery Medical University of Vienna Vienna Austria"},{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Stanford University School of Medicine Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Birgit","family":"Knerer","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery Medical University of Vienna Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian A.","family":"Mueller","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery Medical University of Vienna Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Rotter","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery University Clinic Mannheim, University of Heidelberg Mannheim Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erich","family":"Vyskocil","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery Medical University of Vienna Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Archana","family":"Jaiswal","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology Manchester University NHS Foundation Trust Manchester UK"},{"name":"Department of Otorhinolaryngology, Manchester Centre for Clinical Neurosciences Northern Care Alliance NHS Foundation Trust Salford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0770-6677","authenticated-orcid":false,"given":"Faris F.","family":"Brkic","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery Medical University of Vienna Vienna Austria"},{"name":"Department of Otorhinolaryngology Manchester University NHS Foundation Trust Manchester UK"},{"name":"Department of Otorhinolaryngology, Manchester Centre for Clinical Neurosciences Northern Care Alliance NHS Foundation Trust Salford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajiv","family":"Bhalla","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology Manchester University NHS Foundation Trust Manchester UK"},{"name":"Department of Otorhinolaryngology, Manchester Centre for Clinical Neurosciences Northern Care Alliance NHS Foundation Trust Salford 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