Draf III

INTRODUCTION: and Objectives: Leakage of cerebrospinal fluid (CSF) from the frontal sinus is a challenging condition facing the ENT surgeon. Repair of this condition has been changed nowadays due to the newer instruments and techniques of nasal endoscopy. This study aims to evaluate the outcome of frontal sinus CSF leak endoscopic repair. PATIENTS AND METHODS: Twenty-seven patients who had frontal sinus CSF leaks were included in this study. They were 9 females and 18 males...

BACKGROUND: Frontal sinus cranialization with closure via bifrontal pericranial flaps is the gold standard for separating the nasofrontal recess from the intracranial cavity for posterior table defects. Despite the high success rate, cerebrospinal fluid (CSF) leak may persist and is particularly challenging when vascularized reconstructive options from the bicoronal incision are exhausted. OBJECTIVE: To assess a novel endonasal technique using an adipofascial radial forearm free flap delivered to the frontal recess through a Draf sinusotomy to repair complex CSF leaks from the frontal sinus...

OBJECTIVES/HYPOTHESIS: The periorbital suspension (PS) is an advanced adjunctive technique performed during endoscopic approaches to frontal sinus pathology that would be too far lateral or superior to address using traditional endoscopic transnasal approaches. The objectives of this study are to characterize the utility of this technique for frontal sinus pathology, determine anatomic limitations, and assess clinical outcomes following surgical treatment. STUDY DESIGN: Prospective case series...

BACKGROUND: The aim of this study was to describe the potential advantages of the 3D endoscope-assisted craniectomy for tumor of the nasal cavity. METHODS: A 77-year-old man with a 6 month history of persistent progressive right nasal obstruction and iposmia is reported. Physical examination, including nasal endoscopy, revealed a large mass within the right nasal cavity. He had no associated symptoms such as visual complaints, paresthesia, and facial pain. He worked as a carpenter...

OBJECTIVES: To systematically review the literature to evaluate the indications, safety, and efficacy of the Draf IIb procedure and to evaluate the added advantages of technical factors such as stents and flaps. DATA SOURCES: Articles published until July 2019 on Medline and Cochrane databases. REVIEW METHODS: After a systematic review based on the 2018 PRISMA guidelines was conducted, 26 of 1533 articles were included and reviewed for indications of Draf IIb; surgical technique; use of flaps, stents, grafts, or mitomycin; complications during and after surgery; and success or recurrence rate...

OBJECTIVES/HYPOTHESIS: No studies have evaluated the impact of the types of frontal sinus surgery (FSS) on objective olfaction scores. This study evaluated olfactory function and quality of life (QOL) in chronic rhinosinusitis (CRS) patients before and after total ethmoidectomy with frontal sinusotomy (FS). STUDY DESIGN: Prospective cohort study. METHODS: A prospective study of adult CRS patients undergoing FSS (Draf 2 or Draf 3 procedures) was conducted at a tertiary care center...

PURPOSE: Empty nose syndrome (ENS) is characterized by nasal dryness, crusting, and paradoxical nasal obstruction most commonly after inferior turbinate resection. ENS has also been reported to occur after middle turbinate resection (MTR), and concern for causing ENS is a possible reason surgeons preserve the MT during endoscopic sinus surgery (ESS). The objective was to determine whether MTR during ESS led to ENS. MATERIALS AND METHODS: This was a prospective case series of 95 consecutive patients that underwent bilateral subtotal MTR during ESS with either Draf IIB or Draf III frontal sinusotomies, for chronic rhinosinusitis with or without nasal polyps, and frontal sinus inverted papillomas...

The current literature lacks strong guidelines regarding surgical management of patients with aspirin-exacerbated respiratory disease (AERD), who present with the clinical triad of chronic rhinosinusitis with nasal polyposis (CRSwNP), bronchial asthma, and aspirin/nonsteroidal anti-inflammatory drug intolerance. To further define the effectiveness of sinus surgery in treating AERD patients, this review article discusses current evidence regarding outcomes associated with more extensive surgery, the benefits of frontal sinus surgery on polyposis, and the role of Draf III intervention...

INTRODUCTION: Reconstruction of skull base defects are determined by size, location, and complexity of the defect. METHODS: Case report. CASE DISCUSSION: An 11-year old girl presented with a right frontoethmoidal encephalocele after an episode of meningitis. An endoscopic approach was performed with a Draf III to provide exposure. The skull base defect extended superolateral over the orbit, which limited the choice of reconstructive options...

Draf III frontal sinusotomy is one of the most complex surgical procedures on the frontal sinus, designed to limit the risks of restenosis by ensuring unification of the two ostia and resection of the floor of the sinus. This procedure requires a good knowledge of anatomy and sufficient surgical expertise to avoid the risk of CSF leak and to limit the risk of restenosis. The surgeon can use various landmarks, consisting of foramina, bone grooves and arteries located on the anterior part of the cribriform plate to guide the procedure...

OBJECTIVES: First-line treatment of chronic rhinosinusitis includes topical corticosteroids aimed at decreasing inflammation of sinonasal mucosa. No guidelines exist regarding the effect of head position during administration of corticosteroids. We hypothesize certain positions enhance delivery to the paranasal sinuses, with further improvement in delivery after sinus surgery. METHODS: A systematic review of the literature was conducted using Medline Ovid, Embase, Scopus, and Cochrane databases...

OBJECTIVE: Frontal sinus osteomyelitis is a severe complication which can result from chronic rhinosinusitis, trauma, or as a complication of reconstruction or obliteration of the frontal sinus. The objective of the current study is to evaluate the contemporary management of frontal sinus osteomyelitis in light of recent advancements in endoscopic surgical techniques. METHODS: Review of a prospectively collected database of patients with frontal sinus pathology was performed from 2008-2020...

PURPOSE: To evaluate frontal sinus complications developed after previous external craniotomies requiring frontal sinus reconstruction and their treatment with an endoscopic approach. METHODS: We retrospectively evaluated 22 patients who referred to Sant'Orsola-Malpighi University Hospital and Bellaria Hospital (Bologna, Italy) between 2005 and 2017. All patients presented with frontal sinus disease after frontal craniotomy with sinus reconstruction performed to treat various pathological conditions...

Inverted papilloma (IP) is a rare benign tumor that originates from nasal and paranasal sinus mucosa. Although it is considered a benign lesion, it is locally aggressive and has risk between 7 and 15% for malignant transformation. The management of frontal sinus (FS) IP is still challenging due to its rarity and local invasiveness. We report a rare case of IP originating from FS, and to review the literature to delineate the possible surgical strategy. A 52-year-old male presented with long-standing history of bilateral nasal obstruction and left eye proptosis...

Introduction  The frontal sinus (FS) is the most complex of the paranasal sinuses due to its location, anatomical variations and multiple clinical presentations. The surgical management of the FS and of the frontal recess (FR) is technically challenging, and a complete understanding of its anatomy, radiology, main diseases and surgical techniques is crucial to achieve therapeutic success. Objectives  To review the FS and FR anatomy, radiology, and surgical techniques. Data Synthesis  The FS features a variety of anatomical, volumetric and dimensional characteristics...

BACKGROUND: Visualization and instrumentation of the frontal sinus is not always possible with a Draf III or modified endoscopic Lothrop procedure (MELP), and external incisions can help augment exposure. We compare lateral frontal sinus access using only a MELP compared to the adjunctive transcaruncular approach and transcutaneous Lynch incision. METHODS: Twelve cadaveric heads underwent thin-cut computed tomography scanning. Measurement of the frontal beak, anteroposterior depth of the frontal sinus, and interorbital distance was performed...

PURPOSE: We present our case series of four adult patients with Pott's puffy tumour (PPT), successfully treated with Draf III over a mean period of 11 months. A critical review of the literature is also provided. METHODS: A retrospective review of patients undergoing Draf III for PPT from January 2018 to January 2019 was performed. RESULTS: Four consecutive male patients ranging from 26 to 62 years, with a mean age of 49.5 ± 16.3 years, undergoing Draf III for Pott's puffy tumour were included...

Purpose : We describe a novel surgical approach for bilateral orbital roof decompression using a frontal osteoplastic flap without frontal sinus obliteration. This technique utilizes a combined external and endonasal endoscopic approach for wide exposure to the orbital roof bilaterally. We demonstrate this technique for the resection of a massive frontal fibrous dysplasia lesion in a healthy male with bilateral orbital roof involvement. The endonasal endoscopic portion of the technique includes a Draf III frontal sinusotomy (endoscopic modified Lothrop procedure) which precludes the need for frontal sinus obliteration, restores normal frontal sinus function, and allows for postoperative endoscopic surveillance...

A rare case of palpebral cellulitis with simultaneous frontal sinusitis and osteomyelitis is reported. A healthy 45-year-old man presented with left upper eyelid swelling. He was given intravenous meropenem at the local hospital, but he failed to improve. Magnetic resonance imaging showed left frontal and maxillary sinusitis and upper palpebral cellulitis with an abscess. His temperature was 37.6°C, C-reactive protein was 1.36 mg/dL, thyroid hormone was elevated, left best-corrected visual activity was 1.2, and intraocular pressure was 25 mm Hg...

Orbitofrontal cholesterol granuloma is a rare occurrence. Here, we present a case involving a 64-year-old man with a recurrent orbitofrontal cholesterol granuloma treated by the Modified Lothrop (Draf III) procedure. The patient, who had a history of trauma and previous sinus surgery, presented with chief complaints of nasal congestion, olfactory impairment, and diplopia. We suspected chronic sinusitis; computed tomography showed a soft-tissue shadow extending from the bilateral frontal sinuses to the ethmoid sinuses, with a cyst in the right orbitofrontal region...