PMID- 33086859
OWN - NLM
STAT- MEDLINE
DCOM- 20210818
LR  - 20210818
IS  - 1945-8932 (Electronic)
IS  - 1945-8932 (Linking)
VI  - 35
IP  - 4
DP  - 2021 Jul
TI  - Sinus Irrigation Penetration After Proposed Modified Draf IIa Technique in a 
      Side-to-Side Cadaveric Model.
PG  - 487-493
LID - 10.1177/1945892420969141 [doi]
AB  - BACKGROUND: Endoscopic sinus surgery (ESS) is an effective intervention for 
      patients with medically refractory chronic rhinosinusitis. Frontal sinusotomy is 
      the most challenging part of ESS, with one of the key outcomes being access for 
      topical irrigations. OBJECTIVE: The purpose of this study is to compare 
      irrigation penetration into the frontal sinus following Draf IIa versus modified 
      Draf IIa frontal sinusotomy. METHODS: Four fresh cadaver heads were used in this 
      experiment. Draf IIa was performed on one side of each head and a modified Draf 
      IIa on the contralateral side. This proposed modification consists of a Draf IIa 
      combined with an agger nasi punch-out procedure and partial trimming of the 
      vertical lamella of the middle turbinate back to the posterior table of the 
      frontal sinus without drilling the beak. Each head was irrigated with methylene 
      blue-dyed water and recorded by rigid endoscopy through an endonasal view (EV) of 
      the frontal sinus and frontal trephination view (TV). Two blinded rhinologists 
      scored the extent of staining (using an ordinal scale of 0 to 3) for each side. A 
      case report where the modified Draf IIa was performed is also described. RESULTS: 
      After modified Draf IIa sinuosotomy, the mean score for the EV was 2.125 and for 
      the TV was 2, versus 0.875 and 0.625 for traditional Draf IIa, respectively. 
      There was a statistically significant increase for both EV (p = 0.019) and TV 
      (p = 0.018) after modified Draf IIa. CONCLUSION: In our cadaveric model, this 
      procedural modification improved penetration of postoperative irrigations into 
      the frontal sinus. This simple technique may be easily adapted into frontal ESS 
      when indicated.
FAU - Issa, Khalil
AU  - Issa K
AUID- ORCID: 0000-0003-1899-5109
FAU - Teitelbaum, Jordan I
AU  - Teitelbaum JI
AD  - Division of Rhinology & Endoscopic Skull Base Surgery, Department of Head and 
      Neck Surgery & Communications Sciences, Duke University Medical Center, Durham, 
      North Carolina.
FAU - Jang, David W
AU  - Jang DW
AD  - Division of Rhinology & Endoscopic Skull Base Surgery, Department of Head and 
      Neck Surgery & Communications Sciences, Duke University Medical Center, Durham, 
      North Carolina.
FAU - Goldstein, Bradley J
AU  - Goldstein BJ
AD  - Division of Rhinology & Endoscopic Skull Base Surgery, Department of Head and 
      Neck Surgery & Communications Sciences, Duke University Medical Center, Durham, 
      North Carolina.
FAU - Chan, Lyndon
AU  - Chan L
AD  - Division of Rhinology & Endoscopic Skull Base Surgery, Department of Head and 
      Neck Surgery & Communications Sciences, Duke University Medical Center, Durham, 
      North Carolina.
FAU - Hachem, Ralph Abi
AU  - Hachem RA
AD  - Division of Rhinology & Endoscopic Skull Base Surgery, Department of Head and 
      Neck Surgery & Communications Sciences, Duke University Medical Center, Durham, 
      North Carolina.
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20201021
PL  - United States
TA  - Am J Rhinol Allergy
JT  - American journal of rhinology & allergy
JID - 101490775
SB  - IM
MH  - Cadaver
MH  - Endoscopy
MH  - *Frontal Sinus/surgery
MH  - Humans
MH  - *Sinusitis/surgery
MH  - Therapeutic Irrigation
OTO - NOTNLM
OT  - Draf IIA
OT  - endoscopic sinus surgery
OT  - frontal sinusotomy
OT  - irrigations
OT  - surgical technique
OT  - topical therapy
EDAT- 2020/10/23 06:00
MHDA- 2021/08/19 06:00
CRDT- 2020/10/22 05:25
PHST- 2020/10/23 06:00 [pubmed]
PHST- 2021/08/19 06:00 [medline]
PHST- 2020/10/22 05:25 [entrez]
AID - 10.1177/1945892420969141 [doi]
PST - ppublish
SO  - Am J Rhinol Allergy. 2021 Jul;35(4):487-493. doi: 10.1177/1945892420969141. Epub 
      2020 Oct 21.