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Georgalas, Christos et al.: 2022 The Frontal Sinus DOI: 10.1055/b-0042-184507
Section II Endoscopic Surgical Approaches to Frontal Sinus Disease

8 Draf III (Endoscopic Modified Lothrop)— Inside-Out and Outside-In Approaches

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Editors: Georgalas, Christos; Sama, Anshul

Authors: Abuzeid, Waleed M.; Adappa, Nithin D.; Ahmed, Shahzada; Alasousi, Fahad; Alobid, Isam; Al-Rasheed, Abdulaziz; Alt, Jeremiah A.; Avdeeva, Klementina; Banks, Catherine; Barnes, Martyn; Basak, Hazan; Batra, Pete S.; Battaglia, Paolo; Bernal-Sprekelsen, Manuel; Beton, Suha; Brand, Yves; Breedveld, Paul; Briner, Hans Rudolf; von Buchwald, Christian; Carrau, Ricardo L.; Carrie, Sean; Castelnuovo, Paolo; Chatzinakis, Vasileios; Chen, Philip A.; Chute, Deborah; Clarke, Caroline S.; Conley, David B.; Constable, James; Craig, John R.; Dadgostar, Anali; Dallan, Iacopo; DelGaudio, John M.; Diamantopoulos, Ioannis I.; Badawey, M Reda El; Eloy, Jean Anderson; Fakhri, Samer; Fastenberg, Judd H.; Fazio, Enrico; Felding, Ulrik A.; Fried, Marvin P.; Getz, Anne E.; Ghogomu, Nsangou; Gotlib, Tomasz; Gudis, David A.; Hadjihannas, Edward; Harvey, Richard J.; Herman, Philippe; Hettige, Roland; Hopkins, Claire; Husain, Qasim; Ioannidis, Dimitris; Jankowski, Roger; Javer, Amin; Jeyarajan, Hari; Kanumuri, Vivek V.; Karligkiotis, Apostolos; Kern, Robert C.; Khoueir, Nadim; Jankowski, Roger; Javer, Amin; Jeyarajan, Hari; Kanumuri, Vivek V.; Karligkiotis, Apostolos; Kern, Robert C.; Khoueir, Nadim; Maza, Guillermo; McHugh, Kelsey; Meço, Cem; Mencacci, Lodovica Cristofani; Morris, Stephen; Morrissey, David; Nair, Salil; Narayanan, Prepageran; Orlandi, Richard R.; Palmer, Charles F.; Palmer, James N.; Parasher, Arjun K.; Patel, Zara M.; Pfisterer, Michael J.; Philpott, Carl M.; Pietrobon, Giacomo; Polev, Georgiy A.; Prevedello, Daniel M.; Psaltis, Alkis J.; Ramakrishnan, Yujay; Rokade, Ashok; Roxbury, Christopher; Sacks, Raymond; Sansoni, E. Ritter; Santamaría-Gadea, Alfonso; Schlosser, Rodney J.; Seccia, Veronica; Sindwani, Raj; Smith, Kristine A.; Speleman, Kato; Subramaniam, Soma; Šurda, Pavol; Tajudeen, Bobby A.; Tan, Neil Cheng-Wen; Tang, Dennis; Tang, Ing Ping; Tarabichi, Osama; Tewfik, Marc A.; Tipirneni, Kiranya E.; Turri-Zanoni, Mario; Walters, Benjamin K.; Woodworth, Bradford A.; Wormald, Peter John; Youssef, Ahmed

Title: The Frontal Sinus

Subtitle: Surgical Approaches and Controversies

Print ISBN: 9783132400528; Online ISBN: 9783132437845; Book DOI: 10.1055/b-006-163737

1. Edition © 2022. Thieme. All rights reserved.
Georg Thieme Verlag KG, Stuttgart

Subjects: Otorhinolaryngology, Phoniatrics, Audiology

Thieme Clinical Collections (English Language)



 
Christos Georgalas, Vasileios Chatzinakis, Klementina Avdeeva, Georgiy A. Polev, and Anshul Sama

Abstract

In 1991 in Fulda, Professor Wolfgang Draf developed the type 3 median drainage procedure 1 (endoscopic modified Lothrop, 2 bilateral frontal sinus drillout, 3 nasofrontal approach IV 4 ) as a valid alternative to frontal sinus obliteration. Compared with the osteoplastic flap approach, Draf III avoids problems such as cutaneous scarring, cosmetic deformity as well as late-onset mucoceles while preserving the natural drainage of the frontal sinus. Initial reports showed significant complications including rates of cerebrospinal fluid (CSF) leak as high as 11%. 5 However, over time and in experienced hands it was a safe procedure with minimal and rare complications, 6 and in appropriately selected cases, it results in significant improvement in the patients’ quality of life. 7

Draf III is the complete drillout of the floor of the frontal sinus, frontal beak, intersinus septum, and, importantly, an adjacent part (anterosuperior) of the nasal septum. Resection of the anterosuperior part of nasal septum allows binostril intraoperative manipulation and provides access to lateral areas of the frontal sinus. If the surgery does not include the maximally possible drainage (i.e., when intersinus septum is not completely removed), the term modified Draf III could be used.

In the following chapter indications and surgical techniques of both standard Draf III and outside-in frontal sinus drillout are described. It also includes possible complications and the ways of avoiding them and dealing with them, if any occurred. Photos of step-by-step dissection and some relevant cases are illustrated.

Key words

Draf III - modified endoscopic Lothrop procedure - frontal sinus floor drillout - frontal sinus - endoscopic sinus surgery - indications - complications
 
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