Draf III Frontal Sinus Surgery: “How I Do It”

Abstract

Background The Draf III approach to the frontal sinus can be used during revision endoscopic sinus surgery for chronic rhinosinusitis and to provide access for tumor resection, mucoceles, and repair of cerebrospinal fluid leaks. Objective To describe a simple and safe way to perform a Draf III approach by using the “outside-in” approach. Methods By using a 0° endoscope and a single 15o, 5-mm, coarse diamond burr, the main steps of the procedure are the following: (1) elevation of the mucosal flaps and creation of the septal window, (2) drilling out the frontal beak, (3) creation of neo-ostium and removal of the interfrontal septum, (4) joining the neo-ostium with the frontal recesses, (5) smoothing off the cavity and lowering of the “frontal T,” and (6) use of mucosal flaps and grafts to cover exposed bone. Conclusion This approach is a quick and easy way to perform a Draf III, and reduces operative time and minimizes complications.