Clin Exp Otorhinolaryngol.  2015 Mar;8(1):34-38. 10.3342/ceo.2015.8.1.34.

Extended Draf IIb Procedures in the Treatment of Frontal Sinus Pathology

• Gotlib T
• Held-Ziolkowska M
• Niemczyk K

• KMID: 1973485
• DOI: http://doi.org/10.3342/ceo.2015.8.1.34

Abstract

OBJECTIVES
Draf IIb approach provides wide, unilateral access to the frontal sinus. This approach can be extended without destruction of the contralateral frontal sinus drainage pathway, performed during Draf III (modified Lothrop) procedure. There is limited data in the literature regarding the use of modified Draf IIb procedures.
METHODS
Patients treated with extended Draf IIb procedures in a single center were retrospectively assessed.
RESULTS
Ten patients were identified, including 2 cases of osteoma, 1 inverted papilloma, 1 carcinoma, 5 mucoceles, and 1 chronic rhinosinusitis patient. Six patients had undergone prior surgery, including external procedures in 3 cases. Modifications of Draf IIb were classified as the following: removal of the anterosuperior nasal septum adjacent to the nasal beak, removal of the intersinus septum, and a combination of the above-mentioned methods (upper nasal septum and intersinus septum removal). There were 3 patients operated on with type 1 modification, one patient with type 2 modification, and 6 patients with type 3 modification. There were no perioperative complications.
CONCLUSION
In selected cases, extended Draf IIb procedures are safe and effective in the treatment of frontal sinus disease.

Keyword

Endoscopy; Frontal Sinus; Surgery

MeSH Terms

Animals
Beak
Drainage
Endoscopy
Frontal Sinus*
Humans
Mucocele
Nasal Septum
Osteoma
Papilloma, Inverted
Pathology*
Retrospective Studies

Figure

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  Fig. 1 Schematic drawing of the resection area in the coronal plane. (A) Draf IIb, (B) extended Draf IIb.1, (C) extended Draf IIb.2 (mini-Lothrop), and (D) extended Draf IIb.3.

• 

  Fig. 2 Preoperative computed tomography (A) and magnetic resonance imaging (B) of the patient with sinonasal carcinoma treated with the extended Draf IIb.1.

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  Fig. 3 Computed tomography before (A, C) and after the surgery (B, D). (A, B) Patient with osteoma treated with the extended Draf IIb.1. (C, D) Patient with mucocele as a consequence of osteoplastic flap procedure, treated with the extended Draf IIb.2 (mini-Lothrop) procedure.

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  Fig. 4 Preoperative computed tomography (A) and magnetic resonance imaging (B) of the patient with inverted papilloma of the frontal sinus treated with the extended Draf IIb.3. Attachment of the tumor was found on the posterior table of the left frontal sinus. Small part of the tumor, which crossed the midline, was overhanging with no attachment on the right side.

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  Fig. 5 Patient with right-sided frontal sinus mucocele treated with the extended Draf IIb.3. Computed tomography before the procedure (A, C); endoscopic view through the right nasal passage after the Draf IIb.3 procedure (B, D), intraoperative view (B) and postoperative view (D). Arrows indicate the site of the mucocele; circles indicate the frontal intersinus septal cell; diamonds represent site of communication between frontal intersinus septal cell and left frontal sinus.

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