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Treatment of frontal sinus using surgery is complicated owing to the complex anatomical structure of the sinus region. The aim of the present study was to investigate the efficacy and safety of Draf IIb endoscopic frontal sinus surgery treatment for frontal sinus lesions using the agger nasi approach on 19 patients (28 left or and right nasal cavit...
Context in source publication
Context 1
... The operation was performed under general anes- thesia. A 0˚nasal0˚nasal endoscope (7230AA, Karl Storz, Tuttlingen, Germany) with conventional surgical resection and uncinate process between the middle turbinate and lateral nasal wall of the fornix was performed to remove the nasal dome surface mucosa. An incision of ~10-12 mm height with 45˚of45˚of sphenoid sinus rongeur was made to completely remove the agger nasi posterior wall, a top wall and frontal surface. A resection of the frontal process of the upper maxilla to lamina papyracea plane was performed. To reach the anterior ethmoidal artery a 15-mm incision was made from the front to the back up to the middle turbinate before the attachment part. Subsequently, resection of the bottom wall of a frontal sinus of the middle turbinate and medial attachment up to the ostium of the frontal sinus medial to the nasal septum was performed. To expose the top and anterior walls of the frontal sinus, a section of the frontal ridges was ground using a frontal drill (1883672HS, Medtronic, Minneapolis, MN, USA). Frontal sinus lesions are shown clearly in Fig. 2. Fully open ostium of the frontal sinus is shown in Fig. 3. For the intraoperative treatment of frontal sinus inverted papilloma, drill grinding was employed with the exception of basal tumor bone and electric coagulation of the root. Hemostatic and anti-adhesive material were utilized as a rapid ...
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Background: Extensive nasal polyp growth in the paranasal sinuses can lead to bone erosion of the sinus walls and cause facial disfigurement due to continuous pressure or chronic inflammation. This extremely rare phenomenon is called Woakes syndrome. This syndrome consist of several symptoms include the destruction of ethmoid sinus that cause broad...
Citations
Objective
A variety of approaches for resection of the ossifying fibromas in sinonasal cavities have been described. However, for those involving the anterior skull base, endoscopic surgery remains challenging because of limitations in identification of tumor boundaries from the anterior skull base and proper control of the tumor-feeding vessel. This study aimed to describe a technique for resection of ossifying fibromas involving the anterior skull base through an endoscopic endonasal trans-agger nasi approach, based on anatomic studies and surgeries.
Methods
Two human cadaveric heads were prepared for study of the anatomic relationship between agger nasi and anterior skull base. Two clinical cases were used to illustrate the technique and feasibility of the approach.
Results
The agger nasi was located anterior and inferior to the frontal ostium and the anterior skull base. The frontal ostium and anterior skull base could be visualized and accessed under the 0-degree endoscope by removing the agger nasi. Application of the endoscopic endonasal trans-agger nasi approach in the two patients resulted in complete resection of the tumors with no surgical complications.
Conclusions
An endoscopic endonasal trans-agger nasi approach provides a direct access to the anterior skull base. It would be feasible, effective, and safe for selected cases of ossifying fibroma involving anterior skull base.
Objectives
To systematically review the literature to evaluate the indications, safety, and efficacy of the Draf IIb procedure and to evaluate the added advantages of technical factors such as stents and flaps.
Data Sources
Articles published until July 2019 on Medline and Cochrane databases.
Review Methods
After a systematic review based on the 2018 PRISMA guidelines was conducted, 26 of 1533 articles were included and reviewed for indications of Draf IIb; surgical technique; use of flaps, stents, grafts, or mitomycin; complications during and after surgery; and success or recurrence rate.
Results
The main indication for Draf IIb was chronic frontal rhinosinusitis (61.82%). The postoperative patency rate was 87.85%. When flaps/grafts were applied, the rate was 93.5%, but their added value was not statistically significant. Stents could be an alternative for revision surgery. Treating frontal pathologies other than chronic rhinosinusitis was also satisfying. Safety was comparable to Draf III: no perioperative complications were reported, only a few postoperative ones (eyelid ecchymosis and periorbital cellulitis in 0.2% of the cases, hyposmia in 1.55%).
Conclusion
When properly indicated, Draf IIb frontal drilling is a safe and highly effective surgical technique for frontal pathology treatment, with efficiency and safety comparable to the Draf III, making it a valid option when a bilateral approach is not needed. More studies are required to confirm the added values of flaps, grafts, and stents.
