Modified Lothrop (Draf III) procedure for the treatment of a recurrent orbitofrontal cholesterol granuloma: A case report

Abstract

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. We performed endoscopic surgery for removal of the mass, and histopathological analysis of the resected specimen confirmed a diagnosis of cholesterol granuloma. The lesion recurred 2 months later, and we performed revision surgery using the Modified Lothrop or Draf III procedure. The patient showed no relapse at the 5-year follow-up. These findings suggest that the Draf III procedure is an effective surgical treatment for cholesterol granulomas.

Fenestration is a logical and effective treatment for a large primordial cyst with cholesterol granuloma: a case report

“…Although there are a few reports on the recurrence of CG, 2 , 21 complete removal of the CG tissue is necessary to prevent its recurrence. 3 Surgical excision with curettage is a highly effective method of CG removal because it provides a low rate of recurrence without excessive bone removal.…”

“… 1 The lesion is histopathologically defined by the presence of giant cells, plasma cells, lymphocytes surrounding cholesterol clefts, and hemosiderin deposits. 2 , 3 Obstructed drainage and impaired ventilation are thought to be significant etiological factors of CGs.…”