Top

European Archives of Oto-Rhino-Laryngology

Published in:

07-07-2023 | Sinus Surgery | Rhinology

Recreating the microscopic direct access Draf 2a frontal sinusotomy in the endoscopic era and comparison to an angled instrument approach

Authors: Andrea Sit, Kachorn Seresirikachorn, Alexander S. Zhang, João Mangussi-Gomes, Dichapong Kanjanawasee, Lu Hui Png, Larry Kalish, Raewyn G. Campbell, Raquel Alvarado, Richard J. Harvey

Published in: European Archives of Oto-Rhino-Laryngology | Issue 12/2023

Abstract

Purpose

Microscopic Draf 2a frontal sinusotomy relied on direct access. However, the modern-day endoscopic approach is hindered by the anterior–posterior dimensions of the frontal recess. The nasofrontal beak, angled endoscopes, and variable frontal recess anatomy make the surgery challenging. Carolyn's window frontal sinusotomy removes the limitation of anterior–posterior dimensions and is an endoscopic version of the microscopic Draf 2a. This study aims to compare the perioperative outcomes and morbidity from endoscopic direct access Draf 2a compared to angled access Draf 2a.

Methods

Consecutive adult patients (> 18 years) seen at a tertiary referral clinic who underwent Draf 2a frontal sinus surgery using either endoscopic direct access (Carolyn’s window) or endoscopic angled instrumentation were included. Patients who underwent Carolyn's window were compared to those with angled Draf 2a frontal sinusotomy.

Results

One hundred patients (age 51.96 ± 15.85 years, 48.0% female, follow-up 60.75 ± 17.34 months) were included. 44% of patients used Carolyn's window approach. 100% [95% CI 98.2–100%] of patients achieved successful frontal sinus patency. Both groups were comparable for early morbidities (bleeding, pain, crusting, and adhesions) and late morbidities (retained frontal recess partitions). There were no other morbidities in the early and late postoperative periods.

Conclusion

The endoscopic direct access Draf 2a, or Carolyn’s window, removes the anteroposterior diameter limitation. The frontal sinus patency and early and late surgical morbidities of direct access Draf 2a were comparable with the angled Draf 2a frontal sinusotomy. Surgical modifications, often with drills and bone removal, can be successfully made to enhance access in endoscopic sinus surgery without concern for additional morbidity.

Wormald PJ, Bassiouni A, Callejas CA et al (2017) The international classification of the radiological complexity (ICC) of frontal recess and frontal sinus. Int Forum Allergy Rhinol 7(4):332–337. https://doi.org/10.1002/alr.21893CrossRefPubMed

Bent JP, Cuilty-Siller C, Kuhn FA (1994) The frontal cell as a cause of frontal sinus obstruction. Am J Rhinol 8(4):185–192. https://doi.org/10.2500/105065894781874278CrossRef

Wormald PJ, Hoseman W, Callejas C et al (2016) The international frontal sinus anatomy classification (IFAC) and classification of the extent of endoscopic frontal sinus surgery (EFSS). Int Forum Allergy Rhinol 6(7):677–696. https://doi.org/10.1002/alr.21738CrossRefPubMed

Barham HP, Ramakrishnan VR, Knisely A et al (2016) Frontal sinus surgery and sinus distribution of nasal irrigation. Int Forum Allergy Rhinol 6(3):238–242. https://doi.org/10.1002/alr.21686CrossRefPubMed

Barham HP, Hall CA, Hernandez SC et al (2020) Impact of Draf III, Draf IIb, and Draf IIa frontal sinus surgery on nasal irrigation distribution. Int Forum Allergy Rhinol 10(1):49–52. https://doi.org/10.1002/alr.22447CrossRefPubMed

Draf W (1991) Endonasal micro-endoscopic frontal sinus surgery: the Fulda concept. Oper Techn Otolaryngol-Head Neck Surg. 2(4):234–240. https://doi.org/10.1016/S1043-1810(10)80087-9CrossRef

Draf W, Weber R (1993) Endonasal micro-endoscopic pansinusoperation in chronic sinusitis. I. Indications and operation technique. Am J Otolaryngol 14(6):394–398. https://doi.org/10.1016/0196-0709(93)90112-kCrossRefPubMed

Wormald PJ (2002) The axillary flap approach to the frontal recess. Laryngoscope 112(3):494–499. https://doi.org/10.1097/00005537-200203000-00016CrossRefPubMed

Pletcher SD, Sindwani R, Metson R (2006) The agger nasi punch-out procedure (POP): maximizing exposure of the frontal recess. Laryngoscope 116(9):1710–1712. https://doi.org/10.1097/01.mlg.0000231743.74993.0bCrossRefPubMed

10.

Seresirikachorn K, Sit A, Png LH et al (2023) Carolyn’s window approach to unilateral frontal sinus surgery. Laryngoscope. https://doi.org/10.1002/lary.30569CrossRefPubMed

11.

Spielman DB, Kim M, Overdevest J, Gudis DA (2021) Zero-degree endoscopic visualization of the frontal sinus predicts improved topical irrigation delivery. Laryngoscope 131(2):250–254. https://doi.org/10.1002/lary.28654CrossRefPubMed

12.

Fokkens WJ, Lund VJ, Hopkins C et al (2020) European position paper on rhinosinusitis and nasal polyps 2020. Rhinology 58(Suppl S29):1–464. https://doi.org/10.4193/Rhin20.600CrossRefPubMed

13.

DeConde AS, Smith TL (2016) Outcomes after frontal sinus surgery: an evidence-based review. Otolaryngol Clin N Am 49(4):1019–1033. https://doi.org/10.1016/j.otc.2016.03.024CrossRef

14.

Silverman JB, Prasittivatechakool K, Busaba NY (2009) An evidence-based review of endoscopic frontal sinus surgery. Am J Rhinol Allergy 23(6):e59-62. https://doi.org/10.2500/ajra.2009.23.3406CrossRefPubMed

15.

Eviatar E, Katzenell U, Segal S et al (2006) The endoscopic Draf II frontal sinusotomy: non-navigated approach. Rhinology 44(2):108–113PubMed

16.

Grayson JW, Cavada M, Harvey RJ (2019) Clinically relevant phenotypes in chronic rhinosinusitis. J Otolaryngol Head Neck Surg 48(1):23. https://doi.org/10.1186/s40463-019-0350-yCrossRefPubMedPubMedCentral

17.

Chin D, Snidvongs K, Kalish L, Sacks R, Harvey RJ (2012) The outside-in approach to the modified endoscopic lothrop procedure. Laryngoscope 122(8):1661–1669. https://doi.org/10.1002/lary.23319CrossRefPubMed

18.

Knisely A, Barham HP, Harvey RJ, Sacks R (2015) Outside-in frontal drill-out: how i do it. Am J Rhinol Allergy 29(5):397–400. https://doi.org/10.2500/ajra.2015.29.4175CrossRefPubMed

Title: Recreating the microscopic direct access Draf 2a frontal sinusotomy in the endoscopic era and comparison to an angled instrument approach
Authors: Andrea Sit
Kachorn Seresirikachorn
Alexander S. Zhang
João Mangussi-Gomes
Dichapong Kanjanawasee
Lu Hui Png
Larry Kalish
Raewyn G. Campbell
Raquel Alvarado
Richard J. Harvey
Publication date: 07-07-2023
Publisher: Springer Berlin Heidelberg
Keywords: Sinus Surgery
Frontal Sinusitis
Published in: European Archives of Oto-Rhino-Laryngology / Issue 12/2023
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI: https://doi.org/10.1007/s00405-023-08098-3

2024 ASCO Annual Meeting

Springer Medicine

Recreating the microscopic direct access Draf 2a frontal sinusotomy in the endoscopic era and comparison to an angled instrument approach

Abstract

Purpose

Methods

Results

Conclusion

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 12/2023

Comparison of temporalis muscle fascia and cartilage grafts for primary type 1 tympanoplasty: a meta-analysis of randomized controlled trials

Impact of processing-latency induced interaural delay and level discrepancy on sensitivity to interaural level differences in cochlear implant users

The potential of the Crystal Cam handheld gamma-camera for preoperative and intraoperative sentinel lymph node localization in early-stage oral cancer

The mast cell: the comfortable third in recent CRS research

Detection of microplastics in patients with allergic rhinitis

Persistent Postural-Perceptual Dizziness (PPPD) and quality of life: a cross-sectional study