Frontal Sinus Irrigation After Draf 2a: Carolyn's Window Versus Angled Frontal Sinusotomy

Area of Science:

• Otolaryngology
• Surgical Innovation
• Rhinology

Background:

• Access to the frontal sinus for effective postoperative irrigation can be challenging with the angled Draf 2a technique.
• Adequate irrigation is vital for managing chronic inflammatory sinus disease.

Purpose of the Study:

• To compare the distribution of frontal sinus irrigation between the angled Draf 2a and Carolyn's window approaches.
• To evaluate the efficacy of Carolyn's window, a modification of Draf 2a, in improving endoscopic access and fluid distribution.

Main Methods:

• Human cadaver heads underwent sequential dissection of angled Draf 2a and Carolyn's window approaches.
• Frontal sinuses were irrigated with fluorescein-labeled water, and fluid distribution was graded using endoscopy.
• Blinded grading assessed lavage distribution on a 0-4 scale, with scores compared between techniques.

Main Results:

• Carolyn's window approach demonstrated significantly greater fluid distribution compared to angled Draf 2a.
• Higher grades of lavage (complete or near-complete) were achieved more frequently with Carolyn's window (56.3% vs. 12.5% for grade 4).
• The median distribution grade was significantly higher for Carolyn's window (4) versus angled Draf 2a (1.5) (p < 0.01).

Conclusions:

• Carolyn's window significantly enhances frontal sinus irrigation distribution over the angled Draf 2a approach.
• This technique offers improved access and distribution, making it robust for postoperative topical therapy in chronic frontal sinus disease.