Vol. 1, Article 3 Neurographics logo Smith, et al.

[an error occurred while processing this directive]

 

Endoscopic Frontal Sinusotomy (Draf II Procedure)

Endoscopic frontal sinusotomy, or Draf II procedure, is indicated for patients with severe forms of chronic frontal sinus disease that have failed after endoscopic frontal recess approach. This extended drainage procedure involves resection of the floor of the frontal sinus from the nasal septum medially, to the lamina papyracea laterally. The dissection involves removal of the anterior face of the frontal recess. Thus, the frontal sinus ostium is enlarged to its maximum dimension. This procedure can be very difficult to distinguish from the endoscopic frontal recess approach (Draf I) on coronal postoperative imaging. Evaluation of multiple consecutive coronal images or sagittal reformatted images can demonstrate extensive removal of the anterior face of the frontal recess and frontal sinus floor when compared to the frontal recess approach. The endoscopic frontal sinusotomy (Draf II) procedure can be easily distinguished from the Draf III procedure by the lack of resection of the superior nasal septum and entire frontal sinus floor.

Schematic diagram of Draf II procedure. In addition to removal of air cells around the frontal recess, the floor of the frontal sinus is resected. (Adapted from Draf, ref. 1)
Coronal CT after bilateral endoscopic frontal sinusotomy (Draf II). The frontal recesses are widely patent. On a single coronal image, the radiographic appearance of this procedure appears similar to that of the frontal recess approach (Draf I).
Schematic diagram of Draf II procedure. In addition to removal of air cells around the frontal recess, the floor of the frontal sinus is resected. (Adapted from Draf, ref. 1)

 

Figs. A-C are coronal images proceeding from anterior to posterior in a 36 year old female with chronic frontal sinusitis who had had multiple previous surgeries. Figs. A through C show surgical changes after bilateral endoscopic frontal sinusotomies. The sagittal reformatted images show the extent of resection of the frontal sinus floor to better advantage than the coronal images alone. Fig. D is a reformatted image through the right sinusotomy defect and Fig. E is from the left. The drainage pathway (arrow) created in the Draf II procedure is more extensive than that created in a Draf I.

 


:: Title Page : Introduction : Frontal Sinus Drainage Procedures : Endoscopic Frontal Recess Approach (Draf I) ::
:: Endoscopic Frontal Sinusotomy (Draf II) : Modified Lothrop Procedure (Draf III) ::
:: Osteoplastic Flap with Frontal Sinus Obliteration :: References and Acknowledgements ::

Copyright © 2001. All rights reserved.
Use of this material without written consent of the author is prohibited.

Return to Neurographics Main Page