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N Khoueir, B Verillaud, P Herman
INTRODUCTION: The extent of bone exposure is one of the major factors contributing to failure of endoscopic frontal sinusotomy procedures. Double flaps providing cover of exposed bone have already been described for Draf III procedures in a cadavre study using posterior and lateral pedicled nasoseptal flaps. As these flaps overlap on the septal side, they cannot be raised from the same nasal cavity in a Draf IIb procedure. We describe a new technique using 2 local mucoperiosteal flaps raised from the same side to entirely cover the bone margins exposed by Draf IIb frontal sinusotomy...
February 15, 2018: European Annals of Otorhinolaryngology, Head and Neck Diseases
Xiaole Song, Dehui Wang, Xicai Sun, Quan Liu, Li Hu, Yurong Gu, Huankang Zhang
OBJECTIVE: The aim of this study was to review the management of sinonasal cerebrospinal fluid (CSF) leaks and outcome of endoscopic repairs and to provide experience regarding leaks at the lateral wall of sphenoid sinus and the posterior wall of frontal sinus. METHODS: Patients who underwent endoscopic repairs of CSF leaks were reviewed. Characteristics of different etiologies were compared, and prognostic factors were analyzed. RESULTS: The study included 144 patients with 150 CSF leaks, in which spontaneous leaks account for 55%...
January 2018: Journal of Craniofacial Surgery
Ranko Mladina, Neven Skitarelić, Cemal Cingi, Lei Chen, Nuray Bayar Muluk
OBJECTIVES: The aim of this study was to better understand the usual learning curve in acquiring endonasal endoscopic sinus and skull base surgery (ESSBS) techniques during the novice training on the lamb's head model. METHODS: Ten novices were asked to perform 10 bilateral dissections on the particular lamb's head each. The dissections were uniform, consisted of 10 well-defined steps, beginning from the simple removal of the inferior turbinate, and ending with more complicated procedures like cerebrospinal fluid leak repair, Draf 3 procedure for the frontal sinus and elevation of the nasal septal flap...
December 12, 2017: Journal of Craniofacial Surgery
N Khoueir, B Verillaud, P Castelnuovo, P Herman
No abstract text is available yet for this article.
December 6, 2017: Clinical Otolaryngology
O Erdur, K Ozturk, K Erkan
BACKGROUND: Re-stenosis and a consequent need for revision surgery are the most common problems in the follow-up period following endoscopic modification of the Lothrop procedure. METHOD: This paper reports a new technique for reconstructing and resurfacing of the posterior frontal recess bone for prevention of re-stenosis. RESULTS: A 46-year-old man presented with a frontal sinus osteoma, and treatment featured an endoscopic modification of the Lothrop procedure...
November 20, 2017: Journal of Laryngology and Otology
Vishal S Patel, Garret Choby, Liang-Chun Shih, Zara M Patel, Jayakar V Nayak, Peter H Hwang
BACKGROUND: Endoscopic Draf 2B and Draf 3 frontal sinusotomies are frequently performed for chronic refractory frontal rhinosinusitis. The purpose of this study was to compare outcomes between Draf 2B and Draf 3 procedures. METHODS: A retrospective cohort study was conducted comparing patients undergoing bilateral Draf 2B vs Draf 3 procedures from 2000 to 2016. Patients with neoplasia, dysplasia, mucocele, cystic fibrosis, or ciliary dyskinesia were excluded. Preoperative disease parameters included number of prior surgeries, presence of polyps, preoperative 22-item Sino-Nasal Outcome Test (SNOT-22) score, frontal Lund-Mackay score, anterior-posterior diameter of the frontal ostium, and Global Osteitis Scoring Scale (GOSS)...
January 2018: International Forum of Allergy & Rhinology
Javaneh Jahanshahi, Mehdi Zeinalizadeh, Hasan Reza Mohammadi, Seyed Mousa Sadrehosseini
BACKGROUND: A frontal sinus leak is uncommon and is seen in ∼15% of cases of patients with cerebrospinal fluid (CSF) rhinorrhea. Now, endonasal endoscopic techniques have been reported to reconstruct skull base defects in the frontal sinus with a favorable outcome. OBJECTIVE: To review our experience in the repair of frontal sinus CSF leaks through an endonasal endoscopic approach. METHODS: Twenty-four patients with a frontal sinus leak who underwent endonasal endoscopic repair entered the study...
November 1, 2017: American Journal of Rhinology & Allergy
Philip Locker, Max Plitt, Peter Papagiannopoulos, Ryan Smith, Bobby A Tajudeen
BACKGROUND: Iatrogenic injury to the trochlea is a potential complication of the Draf III or endoscopic modified Lothrop procedure; however, the location of the trochlea from within the sinus cavity has yet to be clearly characterized. We performed the first cadaveric study assessing the position of the trochlea in relation to the first olfactory neuron, a commonly identified landmark during the Draf III procedure. METHODS: Thirteen external dissections of the trochlea were performed on 7 disarticulated cadaveric heads via an extended Lynch type incision...
November 2017: International Forum of Allergy & Rhinology
A Simon Carney
BACKGROUND: The Draf III approach to the frontal sinus can be used during revision endoscopic sinus surgery for chronic rhinosinusitis and to provide access for tumor resection, mucoceles, and repair of cerebrospinal fluid leaks. OBJECTIVE: To describe a simple and safe way to perform a Draf III approach by using the "outside-in" approach. METHODS: By using a 0° endoscope and a single 15°, 5-mm, coarse diamond burr, the main steps of the procedure are the following: (1) elevation of the mucosal flaps and creation of the septal window, (2) drilling out the frontal beak, (3) creation of neo-ostium and removal of the interfrontal septum, (4) joining the neo-ostium with the frontal recesses, (5) smoothing off the cavity and lowering of the "frontal T," and (6) use of mucosal flaps and grafts to cover exposed bone...
September 1, 2017: American Journal of Rhinology & Allergy
Aria Jafari, Kathryn R Tringale, Bharat A Panuganti, Joseph R Acevedo, John Pang, Adam S DeConde
BACKGROUND: The endoscopic modified Lothrop (Draf-III) surgery has improved treatment of recalcitrant frontal sinus disease, with favorable safety and long-term results. However, the short-term clinical and quality-of-life morbidity after Draf-III relative to less-extensive procedures has yet to be investigated. OBJECTIVE: To evaluate the surgical and quality-of-life outcomes, including the burden of follow-up care, in patients who underwent endoscopic modified Lothrop (Draf-III), and compared these results with a less-extensive intervention, the endoscopic frontal sinusotomy (Draf-IIa)...
July 1, 2017: American Journal of Rhinology & Allergy
Alexander G Chiu
No abstract text is available yet for this article.
July 1, 2017: American Journal of Rhinology & Allergy
Eric T Carniol, Alejandro Vázquez, Tapan D Patel, James K Liu, Jean Anderson Eloy
BACKGROUND: Surgical management of the frontal sinus can be challenging. Extensive frontal sinus pneumatization may form a far lateral or supraorbital recess that can be difficult to reach by conventional endoscopic surgical techniques, requiring extended approaches such as the Draf III (or endoscopic modified Lothrop) procedure. Rigid endoscopes may not allow visualization of these lateral limits to ensure full evacuation of the disease process. METHODS: Here we describe the utility of intraoperative flexible endoscopy in two patients with far lateral frontal sinus disease...
June 1, 2017: Allergy & Rhinology
Yukiko Takahashi, Fumi Shoji, Yukio Katori, Hiroshi Hidaka, Naoya Noguchi, Yasuhiro Abe, Risako Kakuta Kakuta, Takahiro Suzuki, Yusuke Suzuki, Nobuo Ohta, Seiji Kakehata, Yoshitaka Okamoto
OBJECTIVE: Sinonasal inverted papilloma has been traditionally managed with external surgical approaches. Advances in imaging guidance systems, surgical instrumentation, and intraoperative multi-visualization have led to a gradual shift from external approaches to endoscopic surgery. However, for anatomical and technical reasons, endoscopic surgery of sinonasal inverted papilloma extending to the frontal sinuses is still challenging. Here, we present our experience in endoscopic surgical management of sinonasal inverted papilloma extending to one or both frontal sinuses...
November 10, 2016: Otolaryngologia Polska
Monirah Albathi, Murugappan Ramanathan, Andrew P Lane, Kofi D O Boahene
OBJECTIVES: Sinonasal inverting papilloma (IP) is a benign but locally aggressive mucosal neoplasm with a high recurrence rate. Extension into the frontal sinus presents surgical challenges for endonasal resection. This study presents an orbitofrontal approach for managing extensive IP. STUDY DESIGN: Case series. METHODS: Four patients seen between 2012 and 2016 with biopsy-proven IP with lateral frontal sinus extension underwent a combined endonasal and transpalpebral approach for tumor resection...
January 2018: Laryngoscope
Samuel C Leong
INTRODUCTION: The aim of this study was to review the clinical outcomes and efficacy of endoscopic sinus surgery (ESS) in the management of Pott's puffy tumor (PPT). METHODS: Literature PubMed review using a combination of MeSH terms and keywords was undertaken, combined with a single surgeon case series of 3 patients. RESULTS: A total of 29 (20 males, median age 25 years) cases were reviewed. The most common etiology was acute frontal sinusitis (62%), followed by a history of chronic rhinosinusitis (28%)...
June 2017: Annals of Otology, Rhinology, and Laryngology
Ephraim Eviatar, Ahmed Taha, Haim Gavriel
Draf IIb procedure is mostly used in a very narrow frontal recess and in a revision frontal sinus surgery. In most cases, the contralateral sinus is not involved. In order to avoid Draf III procedure's reported disadvantages we have commenced the use of the extended Draf IIb procedures in our center. Patients treated with extended Draf IIb procedure at our center between the years 1997 and 2012 were retrospectively evaluated. This procedure includes further widening of the frontal ostium and recces by excising the adjacent most superior nasal septum...
July 2017: European Archives of Oto-rhino-laryngology
Elena Bernardini, Apostolos Karligkiotis, Susanna Fortunato, Paolo Castelnuovo, Iacopo Dallan
Fungus ball (FB) is an non-invasive form of mycosis, that generally affects immunocompetent and non-atopic subjects. Involvement of the frontal sinus is extremely rare. We report two cases with frontal sinus fungus ball that underwent endoscopic endonasal frontal Draf type IIb or III sinusotomy with complete removal of the cheesy clay-like material. There were no intra-operative or postoperative complications, and no recurrence of disease was evident during the follow-up of 51 and 26 months, respectively. The Draf type IIb or type III frontal sinusotomy seems to be highly effective for the treatment of frontal sinus FB and can represent a valid alternative to the traditional external approaches...
June 2017: European Archives of Oto-rhino-laryngology
Jessica W Grayson, Hari Jeyarajan, Elisa A Illing, Do-Yeon Cho, Kristen O Riley, Bradford A Woodworth
BACKGROUND: Management of frontal sinus trauma includes coronal or direct open approaches through skin incisions to either ablate or obliterate the frontal sinus for posterior table fractures and openly reduce/internally fixate fractured anterior tables. The objective of this prospective case-series study was to evaluate outcomes of frontal sinus anterior and posterior table trauma using endoscopic techniques. METHODS: Prospective evaluation of patients undergoing surgery for frontal sinus fractures was performed...
May 2017: International Forum of Allergy & Rhinology
Conner J Massey, Sean Bury, Jay Diamond, Ameet Singh
INTRODUCTION: Extended endoscopic frontal sinusotomy is often required for surgical management of anterior skull base pathology. Such approaches are necessary for access to pathology and maintenance of postoperative frontal sinus outflow tract drainage. Cold steel instrumentation and endoscopic high-speed microdrills are typically used for bony removal during extended frontal sinus approaches but are associated with certain drawbacks, such as thermal injury and obscuration of the surgical field with bone dust...
November 1, 2016: American Journal of Rhinology & Allergy
John R Craig, James N Palmer, Kai Zhao
BACKGROUND: After sinus surgery, patients are commonly instructed to irrigate with saline irrigations with their heads over a sink and noses directed inferiorly (nose-to-floor). Although irrigations can penetrate the sinuses in this head position, no study has assessed whether sphenoid sinus penetration can be improved by irrigating with the nose directed superiorly (nose-to-ceiling). The purpose of this study was to use a validated computational fluid dynamics (CFD) model of sinus irrigations to assess the difference in sphenoid sinus delivery of irrigations after irrigating in a nose-to-floor vs nose-to-ceiling head position...
May 2017: International Forum of Allergy & Rhinology
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