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Endoscopic Techniques in Frontal Sinus Surgery

  • Devyani Lal
  • Peter H. Hwang
Chapter

Abstract

The frontal sinus is arguably the most challenging paranasal sinus to address surgically. Surgery is technically demanding and carries a higher risk of complications. Postoperative stenosis may necessitate revision surgery. The goals of frontal sinus surgery are to address medically refractory disease effectively while minimizing risks and complications. Clinical indications and expectations of benefit from surgery should be thoughtfully evaluated prior to proceeding with surgery. To perform surgery safely, effectively, and efficiently, the frontal surgeon must commit to mastering knowledge of frontal anatomy and instrumentation. They must develop and hone skills in meticulous tissue handling and commit to zealous postoperative care.

This chapter will detail the editors’ techniques in performing endoscopic frontal sinus surgery. The chapter details practical steps in performing endoscopic frontal sinus surgery. The chapter also highlights clinical indications of the Draf I, Draf II, and Draf III (endoscopic modified Lothrop) procedures. The frontal surgeon must understand the advantages and disadvantages of each endoscopic technique as well as their own level of technical expertise to personalize applications in the clinical realm.

Keywords

Frontal sinusotomy Draf I Draf II Draf III Endoscopic modified endoscopic Lothrop procedure Ethmoidectomy 

Supplementary material

Video 6.1

Right primary frontal dissection (Draf IIA) with audio demonstrating the “ABC “technique for dissection (mp4 48446 kb)

Video 6.2

Infiltration of left lateral nasal wall and axilla with approximately 1 cc solution of lidocaine 1% epinephrine with 1:100,000 using a 25 gauge needle (mp41372 kb)

Video 6.3

Right lateral wall injection followed by performance of a “relaxing incision” (mp4 2302 kb)

Video 6.4

Left primary frontal sinusotomy with dissection of supra-agger cells (mp4 24608 kb)

Video 6.5

Left Draf IIB; handheld instruments (MPG 71874 kb)

Video 6.6

Left Draf IIB with drilling, Silastic stent placement (mp4 20787 kb)

Video 6.7

CSF leak during right Draf IIB with mucosal graft repair (mp4 17779 kb)

Video 6.8

Middle turbinate suture medialization (mp4 3271 kb)

Video 6.9

Balloon-assisted right frontal dissection (mp4 16740 kb)

Video 6.10

Draf III inside-out (MPG 149120 kb)

Video 6.11

Right Draf IIB to address lateralized middle turbinate (mp4 67842 kb)

Video 6.12

Draf IIB for right frontal sinus inverted papilloma (mp4 80854 kb)

Video 6.13

Draf III outside-in for narrow frontal sinus (mp4 20491 kb)

Video 6.14

Frontal trephination for flushing and debridement of tenacious, impacted debris as part of “above and below” approach (mp4 35513 kb)

Video 6.15

Well-healed sinuses (WMV 6740 kb)

Video 6.16

Left injection, relaxing incision, pledget (mp4 5419 kb)

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Devyani Lal
    • 1
  • Peter H. Hwang
    • 2
  1. 1.Department of Otolaryngology – Head and Neck SurgeryMayo Clinic College of Medicine and Science, Mayo ClinicPhoenixUSA
  2. 2.Department of Otolaryngology – Head and Neck SurgeryStanford University School of MedicineStanfordUSA

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