Modified mini‐lothrop/extended draf IIB procedure for contralateral frontal sinus disease: a case series

Abstract

The modified mini-Lothrop procedure/extended Draf IIB represents a feasible approach and adequate alternative to more traditional endoscopic and open frontal sinus procedures in select cases. This modification was successful in addressing difficult to access unilateral frontal sinus disease in this small cohort.

Preventing and Managing Complications in Frontal Sinus Surgery

“…9,25-27 Similar precautions should be undertaken as in any other frontal sinus procedure, including awareness of the location of the skull base and the orbit. Variations in the Draf procedures have been described by Eloy and colleagues, [28][29][30][31][32][33][34] and require the same type of precautions to prevent complications. Frontal sinus surgery series with appreciable numbers of patients are sparse, meaning the true complication rates are not known and likely vary based on characteristics relating to patient selection and surgeon experience.…”

Endoscopic Approaches to the Frontal Sinus

“…9,10 Ipsilateral access to the frontal sinus recess can be hindered by one of many circumstances, including scarring, outflow tract osteogenesis, or fat prolapse from previous medial orbital wall decompression or trauma (Fig. 4).…”

“…4 These investigators have detailed an endonasal approach similar in concept to Lothrop that also involves creating a large common drainage pathway between the paired frontal sinuses. Efforts to reduce invasiveness and preserve the natural architecture of the frontal sinus have led recently to the description of the modified hemi-Lothrop procedure, 5-8 the modified mini-Lothrop procedure, 9,10 and the modified subtotal-Lothrop procedure. 11,12 …”

The “Cross‐court draf IIb” procedure for advanced nasal septum or frontal sinus pathology and nasal septum pathology

“…Devised by the innovative sinus surgeon Wolfgang Draf, the Draf classification system is the most commonly utilized construct to organize advanced surgical approaches to the frontal sinus (Table ) . Additional expanded and adjunct techniques have been described to access the frontal sinus, which largely center on tumor access in difficult lateral anatomic locations or refractory chronic rhinosinusitis (CRS) short of the Draf III procedure . Realistically, however, when confronted with refractory frontal sinusitis, many otolaryngologists around the world do not have access to the endoscopic‐powered drills or image guidance.…”