The DrafⅢprocedure involves the creation of a common frontal sinus cavity.The most common indication for the DrafⅢprocedure is chronic rhinosinusitis of the frontal sinuses despite the failure of more conservative i...The DrafⅢprocedure involves the creation of a common frontal sinus cavity.The most common indication for the DrafⅢprocedure is chronic rhinosinusitis of the frontal sinuses despite the failure of more conservative interventions such as bilateral DrafⅡa procedures.Primary DrafⅢmay be indicated in patients with a high risk of failures such as those with severe polyposis and those with a frontal sinus opening less than 4 mm on computed tomography imaging.Other indications for the DrafⅢinclude access for tumor removal and repair of traumatic fractures of the frontal sinus.The"inside-out"DrafⅢprocedure is the standard approach when the frontal recess anterior-posterior diameter is wide enough for instrument access,usually larger than 4-5 mm.The"outside-in"DrafⅢprocedure can be done when the frontal recess is too narrow to safely accommodate instruments.Regular follow-up with debridement should be done to prevent neo-ostium stenosis.展开更多
Objectives:The use of endoscopic approaches has revolutionized the management of frontal sinus(FS)lesions.However,external approaches still play a significant role in select conditions.Various factors determine the de...Objectives:The use of endoscopic approaches has revolutionized the management of frontal sinus(FS)lesions.However,external approaches still play a significant role in select conditions.Various factors determine the decision to utilize endoscopic or external approaches such as the lesion location,extension,and patient's characteristics.The study aims to define certain FS indices for accurate selection of the most suitable approach for each patient.Methods:A descriptive study was performed,based on endoscopic and external cadaveric dissections.Quantitative analyses including horizontal,anteroposterior diameters,and exposure area were performed for each approach using the navigation system.Patients with various FS lesions were included and their data were collected and evaluated.Results:Fifteen cadavers were analyzed.The average anteroposterior diameter on the midsagittal plane was 12.3 mm,distance from the midline to the lateralmost point was 21.8 mm on the right and 23.1 mm on the left side.The exposure area on the right side for DrafⅡa,and DrafⅡb were 64.6,115.0 mm^(2)while on the left side were 67.0,125.0 mm^(2).For DrafⅢ,the exposure area was 377.0 mm^(2).A total of 41 patients were included in the clinical correlation.Conclusions:FS with a narrow anteroposterior diameter and longer horizontal diameter are difficult to access endoscopically,especially for lesions affecting the lateral recess of the sinus,and may require a combination with an external approach.FS approaches can be selected according to the sinus morphology of each patient,the surgeon''s preferences,institutional resources,and the lesion's nature and extension.展开更多
The current literature lacks strong guidelines regarding surgical management of patients with aspirin-exacerbated respiratory disease(AERD),who present with the clinical triad of chronic rhinosinusitis with nasal poly...The current literature lacks strong guidelines regarding surgical management of patients with aspirin-exacerbated respiratory disease(AERD),who present with the clinical triad of chronic rhinosinusitis with nasal polyposis(CRSwNP),bronchial asthma,and aspirin/nonsteroidal anti-inflammatory drug intolerance.To further define the effectiveness of sinus surgery in treating AERD patients,this review article discusses current evidence regarding outcomes associated with more extensive surgery,the benefits of frontal sinus surgery on polyposis,and the role of Draf III intervention.Numerous studies suggest that Draf III frontal sinusotomy may be an efficacious early intervention due to increased neo-ostial patency and subsequent distribution of topical therapies.Future studies that further investigate the efficacy and safety of extensive surgery in AERD patients are warranted.展开更多
文摘The DrafⅢprocedure involves the creation of a common frontal sinus cavity.The most common indication for the DrafⅢprocedure is chronic rhinosinusitis of the frontal sinuses despite the failure of more conservative interventions such as bilateral DrafⅡa procedures.Primary DrafⅢmay be indicated in patients with a high risk of failures such as those with severe polyposis and those with a frontal sinus opening less than 4 mm on computed tomography imaging.Other indications for the DrafⅢinclude access for tumor removal and repair of traumatic fractures of the frontal sinus.The"inside-out"DrafⅢprocedure is the standard approach when the frontal recess anterior-posterior diameter is wide enough for instrument access,usually larger than 4-5 mm.The"outside-in"DrafⅢprocedure can be done when the frontal recess is too narrow to safely accommodate instruments.Regular follow-up with debridement should be done to prevent neo-ostium stenosis.
文摘Objectives:The use of endoscopic approaches has revolutionized the management of frontal sinus(FS)lesions.However,external approaches still play a significant role in select conditions.Various factors determine the decision to utilize endoscopic or external approaches such as the lesion location,extension,and patient's characteristics.The study aims to define certain FS indices for accurate selection of the most suitable approach for each patient.Methods:A descriptive study was performed,based on endoscopic and external cadaveric dissections.Quantitative analyses including horizontal,anteroposterior diameters,and exposure area were performed for each approach using the navigation system.Patients with various FS lesions were included and their data were collected and evaluated.Results:Fifteen cadavers were analyzed.The average anteroposterior diameter on the midsagittal plane was 12.3 mm,distance from the midline to the lateralmost point was 21.8 mm on the right and 23.1 mm on the left side.The exposure area on the right side for DrafⅡa,and DrafⅡb were 64.6,115.0 mm^(2)while on the left side were 67.0,125.0 mm^(2).For DrafⅢ,the exposure area was 377.0 mm^(2).A total of 41 patients were included in the clinical correlation.Conclusions:FS with a narrow anteroposterior diameter and longer horizontal diameter are difficult to access endoscopically,especially for lesions affecting the lateral recess of the sinus,and may require a combination with an external approach.FS approaches can be selected according to the sinus morphology of each patient,the surgeon''s preferences,institutional resources,and the lesion's nature and extension.
文摘The current literature lacks strong guidelines regarding surgical management of patients with aspirin-exacerbated respiratory disease(AERD),who present with the clinical triad of chronic rhinosinusitis with nasal polyposis(CRSwNP),bronchial asthma,and aspirin/nonsteroidal anti-inflammatory drug intolerance.To further define the effectiveness of sinus surgery in treating AERD patients,this review article discusses current evidence regarding outcomes associated with more extensive surgery,the benefits of frontal sinus surgery on polyposis,and the role of Draf III intervention.Numerous studies suggest that Draf III frontal sinusotomy may be an efficacious early intervention due to increased neo-ostial patency and subsequent distribution of topical therapies.Future studies that further investigate the efficacy and safety of extensive surgery in AERD patients are warranted.
