The Role of Frontal Sinus Draf Procedures in Endoscopic Frontoethmoid Dura Repairs

 

Aims: Frontal sinus Draf procedures gradually enable a wider opening to the frontal sinuses, improving endoscopic ease to access and manipulate around dura lesions, as well as leaving an adequate drainage postoperatively. In this study, we investigated the role of Draf procedures in endoscopic management of frontoethmoid CSF fistulas and postoperative frontal sinus drainage patency.

Method: During a12-year period, 167 patients who underwent frontoethmoid duraplasty were evaluated for intraoperative requirement for Draf procedures; postoperative duraplasty success; postoperative frontal sinus drainage and recess patency for ≥6 months in follow-ups; and postoperative requirement for frontal sinus surgery and Draf procedures.

Results: Watertight sealing was achieved in all patients also at frontal sinuses. In 43 patients, type IIB(19 patients) or III(31 patients) drainage was needed during the initial surgery for dura repair and sinus ventilation, and among them only 5(4 type IIB, 1 type III) patients required revision surgery for obstructive frontal drainage problems during the first 6 month follow-ups. Among the rest 127 patients who did not required frontal floor drilling initially, 11 developed obstruction of frontal sinus drainage due to over healing in the first 6 months and required type IIB(4 patients) or III(7 patients) drainage with revision surgery, after which they had no more problems.

Conclusion: Frontal sinus Draf procedures, especially types IIB and III drainage, are important adjuncts in the endoscopic management of CSF rhinorrhea. When necessary, they do not only extend the applicability of endoscopic duraplasty techniques into the frontal sinus, but also help manage and reduce postoperative inflammatory complication rates.