Modified Draf IIB with Frontal Intersinus Septectomy for Contralateral Frontal Sinus Disease: A Cadaveric Study

Friedel, Mph Mark E.; Kuperan, Arjuna B.; Liu, James K.; Eloy, Jean Anderson

doi:10.1002/lary.22115

Cited by 8 publications

(6 citation statements)

References 3 publications

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“…The endoscopic Draf III frontal sinusotomy (modified Lothrop procedure) has replaced more traditional external approaches, such as the osteoplastic flap and frontal obliteration, for addressing recalcitrant obstructive chronic inflammatory disease as well as neoplasms of the frontal sinus . The endoscopic technique has been well described . In the more traditional extended endoscopic approaches to the frontal sinus, 1 or both of the frontal sinuses are entered through their infundibulum and extended in an anteromedial direction to the contralateral side, through the upper perpendicular plate and frontal intersinus septum, creating a horseshoe‐shaped common frontal opening between the orbital processes of the frontal bones.…”

mentioning

confidence: 99%

Nasal branch of the anterior ethmoid artery: a consistent landmark for a midline approach to the frontal sinus

Sahu

Casiano

2019

Int Forum Allergy Rhinol

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Background: Frontal sinusotomy can be challenging when significant scarring or distorted anatomy is present. Identifying a reliable anatomic structure, when traditional landmarks or navigation are absent, may assist the surgeon in revision and complicated frontal sinusotomies via a midline approach. We aimed to characterize the anatomic relationship of the nasal branch of the anterior ethmoid artery (NBAEA) to the frontal infundibulum, specifically the first olfactory fili, posterior frontal infundibulum, and anterior cribriform plate.Methods: Dissection of the NBAEA was carried out in 11 cadaveric heads, resulting in a total of 21 dissections (1 aplastic frontal). Mean with standard deviation and a range were established for 7 relative measurements. Results:The total length of NBAEA cle when present (mean 2.43 mm), the anterior edge of NBAEA cle to anterior infundibulum coronal plane (mean 1.71 mm), the posterior edge of NBAEA cle to posterior infundibulum coronal plane (mean 3.33 mm), the posterior edge of NBAEA cle to 1st olfactory fili (mean 2.86 mm), and the first olfactory fili to posterior infundibulum coronal plane (mean 0.48 mm) were consistent measurements supporting the use of the NBAEA as a consistent anatomical landmark for the correct surgical coronal trajectory into the midline frontal sinus. Conclusion:The NBAEA is a consistent anatomic landmark with minimal intercadaveric and intracadaveric variation. It can be used reliably as a "sentinel artery" notifying the surgeon when one is approaching the first olfactory fili, to determine the correct trajectory into the midline frontal sinus. C 2019 ARS-AAOA, LLC.

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confidence: 99%

Nasal branch of the anterior ethmoid artery: a consistent landmark for a midline approach to the frontal sinus

Sahu

Casiano

2019

Int Forum Allergy Rhinol

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“…In unilateral frontal sinus disease with intersinus septum deviation towards the lesion, ipsilateral extended Draf IIb procedure with removal of the intersinus septum (extended Draf IIb.2 or mini-Lothrop procedure [ 3 , 7 ]) can be a suitable treatment option, especially in cases with the presence of a mucocele ( Fig. 3B ).…”

Section: Discussionmentioning

confidence: 99%

“…The advantage of septal perforation is possibility of bimanual dissection. Another modification of Draf IIb procedure, referred to as mini-Lothrop procedure is performed by removal of the intersinus septum [ 6 , 7 ]. The third possibility is a combination of both of the above-mentioned procedures: removal of the upper nasal septum and the intersinus septum.…”

Section: Introductionmentioning

confidence: 99%

Extended Draf IIb Procedures in the Treatment of Frontal Sinus Pathology

Gotlib

Held-Ziółkowska

Niemczyk

2015

Clin Exp Otorhinolaryngol

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ObjectivesDraf 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.MethodsPatients treated with extended Draf IIb procedures in a single center were retrospectively assessed.ResultsTen 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.ConclusionIn selected cases, extended Draf IIb procedures are safe and effective in the treatment of frontal sinus disease.

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“…Nonetheless, in cases of limited unilateral sinonasal/ASB tumors, the EMLP may lead to unnecessary resection of salvageable sinonasal structures. Previously, we have described 3 less invasive modifications of this technique termed the modified mini‐Lothrop procedure (MMLP), the modified hemi‐Lothrop procedure (MHLP), and the MSLP to address specific frontal sinus and supraorbital ethmoid pathologies in which a complete EMLP is avoidable. The MSLP is designed specifically to provide exposure for access to the bilateral posterior frontal sinus table for unilateral ASB tumor resection with preservation of the contralateral FSR.…”

Section: Discussionmentioning

confidence: 99%

Modified subtotal‐Lothrop procedure for extended frontal sinus and anterior skull‐base access: a case series

Eloy

Mady

Kanumuri

et al. 2014

Int Forum Allergy Rhinol

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Modified Draf IIB with Frontal Intersinus Septectomy for Contralateral Frontal Sinus Disease: A Cadaveric Study

Cited by 8 publications

References 3 publications

Nasal branch of the anterior ethmoid artery: a consistent landmark for a midline approach to the frontal sinus

Nasal branch of the anterior ethmoid artery: a consistent landmark for a midline approach to the frontal sinus

Extended Draf IIb Procedures in the Treatment of Frontal Sinus Pathology

Modified subtotal‐Lothrop procedure for extended frontal sinus and anterior skull‐base access: a case series

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