Recreating the microscopic direct access Draf 2a frontal sinusotomy in the endoscopic era and comparison to an angled instrument approach

Andrea Sit; Kachorn Seresirikachorn; Alexander S Zhang; João Mangussi-Gomes; Dichapong Kanjanawasee; Lu Hui Png; Larry Kalish; Raewyn G Campbell; Raquel Alvarado; Richard J Harvey

doi:10.1007/s00405-023-08098-3

Recreating the microscopic direct access Draf 2a frontal sinusotomy in the endoscopic era and comparison to an angled instrument approach

Eur Arch Otorhinolaryngol. 2023 Dec;280(12):5353-5361. doi: 10.1007/s00405-023-08098-3. Epub 2023 Jul 7.

Authors

Andrea Sit^{1

2}, Kachorn Seresirikachorn^{3

4

5

6

7}, Alexander S Zhang^{1

8}, João Mangussi-Gomes¹, Dichapong Kanjanawasee^{1

9

10}, Lu Hui Png^{1

11}, Larry Kalish^{1

12

13}, Raewyn G Campbell^{1

14

15}, Raquel Alvarado^{1

2}, Richard J Harvey^{1

2

14}

Affiliations

¹ Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.
² School of Clinical Medicine, Faculty of Medicine and Health, St Vincent's Healthcare Clinical Campus, University of New South Wales, Sydney, Australia.
³ Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia. [email protected].
⁴ Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. [email protected].
⁵ Endoscopic Nasal and Sinus Surgery Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. [email protected].
⁶ Doctor of Philosophy Program in Medical Sciences (International Program), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. [email protected].
⁷ Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia. [email protected].
⁸ Department of Otolaryngology, Head and Neck Surgery, St Vincent's Hospital, Sydney, Australia.
⁹ Center of Research Excellence in Allergy and Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
¹⁰ Biodesign Innovation Center, Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
¹¹ Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore, Singapore.
¹² Department of Otolaryngology, Head and Neck Surgery, Concord General Hospital, University of Sydney, Sydney, Australia.
¹³ Faculty of Medicine, University of Sydney, Sydney, Australia.
¹⁴ Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.
¹⁵ Department of Otolaryngology, Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney, Australia.

PMID: 37417998
DOI: 10.1007/s00405-023-08098-3

Abstract

Purpose: Microscopic Draf 2a frontal sinusotomy relied on direct access. However, the modern-day endoscopic approach is hindered by the anterior-posterior dimensions of the frontal recess. The nasofrontal beak, angled endoscopes, and variable frontal recess anatomy make the surgery challenging. Carolyn's window frontal sinusotomy removes the limitation of anterior-posterior dimensions and is an endoscopic version of the microscopic Draf 2a. This study aims to compare the perioperative outcomes and morbidity from endoscopic direct access Draf 2a compared to angled access Draf 2a.

Methods: Consecutive adult patients (> 18 years) seen at a tertiary referral clinic who underwent Draf 2a frontal sinus surgery using either endoscopic direct access (Carolyn's window) or endoscopic angled instrumentation were included. Patients who underwent Carolyn's window were compared to those with angled Draf 2a frontal sinusotomy.

Results: One hundred patients (age 51.96 ± 15.85 years, 48.0% female, follow-up 60.75 ± 17.34 months) were included. 44% of patients used Carolyn's window approach. 100% [95% CI 98.2-100%] of patients achieved successful frontal sinus patency. Both groups were comparable for early morbidities (bleeding, pain, crusting, and adhesions) and late morbidities (retained frontal recess partitions). There were no other morbidities in the early and late postoperative periods.

Conclusion: The endoscopic direct access Draf 2a, or Carolyn's window, removes the anteroposterior diameter limitation. The frontal sinus patency and early and late surgical morbidities of direct access Draf 2a were comparable with the angled Draf 2a frontal sinusotomy. Surgical modifications, often with drills and bone removal, can be successfully made to enhance access in endoscopic sinus surgery without concern for additional morbidity.

Keywords: Endoscopic endonasal surgery; Frontal sinus; Frontal sinusitis; Paranasal sinus diseases; Sinusitis.

MeSH terms

Adult
Aged
Ambulatory Care Facilities
Drainage
Endoscopy / methods
Female
Frontal Sinus* / surgery
Humans
Male
Middle Aged
Treatment Outcome