Chronic Rhinosinusitis (CRS), Draf I or IIa, Frontal Sinusitis, Functional Endoscopic Sinus Surgery (FESS)
Conditions
Keywords
Frontal sinusitis, Direct Draf, Endoscopic sinus surgery
Brief summary
Patients with chronic rhinosinusitis with frontal sinus affection indicated for sinuscopy will be randomly categorized in 2 groups: group A will have endoscopic directDraf IIa frontal sinusotomy and group B will have endoscopic angled Draf IIa frontal sinusotomy, the two groups will be compared according to ostium patency and perioperative morbidity
Detailed description
Frontal sinus surgery is a challenging component of endoscopic sinus surgery due to the intricacy and variability of frontal recess and sinus anatomy. Before the introduction of endoscopy in sinus surgery, complex cases of the frontal sinus were managed through the anterior wall using an osteoplastic flap approach. This technique was relatively successful in treating frontal sinus pathologies, but was invasive with adverse effects and failure in 6-25 percent of patients. Different endoscopic techniques have been introduced for performing frontal sinusotomy. Draf categorized them into four techniques (Draf I, Draf IIa, Draf IIb, Draf III). Draf II procedures widen the frontal sinus outflow tract from the lamina papyracea laterally to the middle turbinate (Draf IIa) or the nasal septum medially (Draf IIb). The thickness of the nasofrontal beak, and a limited anterior-posterior dimension of the frontal recess, make the Draf IIa frontal sinus surgery with angled endoscopy and instrumentation visually diffcult and requires skilled dexterity. The direct access or Carolyn's window approach to the frontal recess replicates Draf's technique via the endoscopic approach. The approach utilizes only the 0° endoscope. In this approach, the entire frontal process of the maxilla, agger nasi and nasal process of the frontal bone, is removed with a high-speed drill.The goal of the approach is to visualize all walls of the frontal sinus via a ° endoscope. This postoperative view predicts better irrigation access and drainage of the frontal sinuses.
Interventions
PROCEDUREEndoscopic direct Draf IIa
Endoscopic direct Draf IIa (Carolyn' window approach) frontal sinusotomy
PROCEDUREEndoscopic angled Draf IIa
Group BFrontal sinusotomy using angled endoscopeand instruments
Sponsors
Assiut University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
1. Adult patients (aged 18 and above) with chronic rhino sinusitis affecting the frontal sinus with or without nasal polyps confirmed by nasal endoscopy and CT scan. 2. Unilateral or bilateral cases. 3. Denovo or recurrent cases.
Exclusion criteria
1. Individuals younger than 18 year-old. 2. Neoplasms
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Assess endoscopic direct access Draf IIa (carolyn's window approach) in creating patent frontal sinusotomy. | 2 years | Assess endoscopic direct access Draf IIa (carolyn's window approach) in creating patent frontal sinusotomy assessment will be done radiologically after 6 months : it will be considered patent if ostium more than 5mm |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Assess perioperative morbidity of endoscopic direct Draf IIa approach compared to endoscopic Draf IIa frontal sinusotomy with an angled endoscope and instrumentation | 2 years | Assess perioperative morbidity of endoscopic direct Draf IIa approach compared to endoscopic Draf IIa frontal sinusotomy with an angled endoscope and instrumentation Defined as early (\< 90 days) or late (\> 90 days). Early morbidity: including 1. bleeding (requiring intervention) 2. pain (requiring additional analgesia) 3. crusting (requiring additional post-op visit) 4. adhesions (any) 5. cerebrospinal fluid leak 6. periorbital edema or hematoma 7. inferior-based lateral wall mucosal flap necrosis. Late morbidity: including epiphora and smell reduction from baseline. |
Contacts
Primary ContactHazem Gamal Noreldin, Assistant lecturer
Outcome results
None listed