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Draf IIB with superior septectomy: finding the "middle ground".
Vidur Bhalla1,2, Kevin J Sykes1, Jennifer A Villwock1
1Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS.
International Forum of Allergy & Rhinology
|December 15, 2018
Summary
A modified Draf IIb endoscopic sinus surgery with superior septectomy (IIb+SS) offers similar sinus irrigation benefits to the endoscopic modified Lothrop procedure (EMLP). This technique may be a valuable alternative for patients requiring revision surgery.
Area of Science:
- Otolaryngology
- Surgical Innovation
- Rhinology
Background:
- Endoscopic sinus surgery (ESS) with Draf IIa has a high failure rate in patients with diffuse polyposis, asthma, and aspirin-exacerbated respiratory disease.
- Many of these patients require progression to the endoscopic modified Lothrop procedure (EMLP).
- A novel modification, Draf IIb with superior septectomy (IIb+SS), is proposed as an alternative.
Purpose of the Study:
- To compare the efficacy of ESS with IIb+SS versus ESS with EMLP in delivering irrigant to sinus cavities.
- To evaluate the distribution of sinus irrigations in cadaver models.
Main Methods:
- Six cadaver heads underwent ESS with IIb+SS, followed by fluorescein-dyed irrigations and video endoscopy.
- EMLP was then performed on the same heads with repeat dye-irrigation and video endoscopy.
- Irrigant penetration was graded by four blinded rhinologists across multiple sinus sites.
Main Results:
- No significant difference in overall irrigant penetration scores between IIb+SS (1.99) and EMLP (1.97) (p=0.816).
- Comparable scores were observed for maxillary, ethmoid, and sphenoid sinuses.
- Slight, non-significant trends favored IIb+SS in frontal sinus and olfactory cleft irrigation.
Conclusions:
- ESS with IIb+SS demonstrates comparable sinus irrigation delivery to EMLP.
- This technique avoids altering natural sinus outflow and circumferential scarring.
- Further investigation is warranted for high-risk revision surgery patients.