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| Name | Endoscopic Draf IIC |
| Video Uploader | Video From John Craig, Rhinology-Skull Base Surgery |
| Upload Date | This Video Uploaded At 05-08-2017 14:49:31 |
| Video Discription | With surgical management of frontal sinus pathology, various endoscopic approaches have been described to open the frontal sinuses both to access the pathology, and also to ensure long-term patency of the frontal outflow tract. The Draf classification system is widely accepted as the framework by which to categorize sequentially more extensive surgical openings to the frontal sinuses. A Draf I is an anterior ethmoidectomy (no removal of the caps of frontal recess cells). A Draf IIA is a standard frontal sinusotomy defined by removal of bony partitions down to the bony boundaries of the frontal recess (results in an opening from the medial orbital wall to the middle turbinate). A Draf IIB is a Draf IIA plus removal of the superior aspect of the vertical portion of the middle turbinate and the medial frontal sinus floor (results in an opening from the medial orbital wall to the nasal septum). A Draf III is a frontal drillout procedure where the frontal intersinus septum and superior nasal septum are removed, connecting the left and right frontal sinuses into a common median drainage pathway (results in the widest bilateral opening possible from one medial orbital wall to the other). A Draf IIC was not in the original Draf classification system, but was termed by Kosmer and Goldberg and was also termed a Modified Mini-Lothrop by Eloy et al. It is similar to a Draf III but it is performed through one nasal cavity contralateral to the side of frontal pathology, such that both frontal sinuses can then drain into one frontal recess and nasal cavity. Indications for this unique approach include situations where the frontal recess on the side of the frontal sinus pathology is inaccessible or severely scarred. The case presented here is a good example of both of these indications. The patient developed a left frontal sinus mucocele due to scarring of the left frontal recess and outflow tract which had developed years after facial fractures sustained in a car accident. The patient needed drainage of the left frontal sinus but the nasal septum was also severely deviated to the left side, preventing left-sided surgical access. Therefore, an endoscopic Draf IIC was performed through the right side to avoid the need for a big septal reconstruction procedure as well as bilateral sinus surgery plus Draf III. This is a very useful and reliable approach for this specific scenario. |
| Category | Science & Technology |
| Tags | frontal sinus | frontal sinus mucocele | frontal sinus surgery | endoscopic frontal sinus surgery | John Craig | Rhinology | Henry Ford Rhinology | endoscopic sinus surgery | frontal sinus trauma | mucocele | Draf III | Draf 3 | Endoscopic Draf 3 | chronic sinusitis | deviated septum |
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