Noller Michael, Fischer Jakob L, Gudis David A, Riley Charles A
Department of Otolaryngology-Head and Neck Surgery Walter Reed National Military Medical Center Bethesda Maryland USA.
Department of Otolaryngology-Head and Neck Surgery, Columbia University Medical Center New York Presbyterian Hospital New York New York USA.
World J Otorhinolaryngol Head Neck Surg. 2022 Mar 22;8(1):1-7. doi: 10.1002/wjo2.6. eCollection 2022 Mar.
The Draf Ⅲ procedure involves the creation of a common frontal sinus cavity. The most common indication for the Draf Ⅲ procedure is chronic rhinosinusitis of the frontal sinuses despite the failure of more conservative interventions such as bilateral Draf Ⅱa procedures. Primary Draf Ⅲ may be indicated in patients with a high risk of failures such as those with severe polyposis and those with a frontal sinus opening less than 4 mm on computed tomography imaging. Other indications for the Draf Ⅲ include access for tumor removal and repair of traumatic fractures of the frontal sinus. The "inside-out" Draf Ⅲ procedure is the standard approach when the frontal recess anterior-posterior diameter is wide enough for instrument access, usually larger than 4-5 mm. The "outside-in" Draf Ⅲ procedure can be done when the frontal recess is too narrow to safely accommodate instruments. Regular follow-up with debridement should be done to prevent neo-ostium stenosis.
DrafⅢ手术包括创建一个共同的额窦腔。DrafⅢ手术最常见的适应证是尽管采用了如双侧DrafⅡa手术等更保守的干预措施但额窦仍患有慢性鼻窦炎。对于失败风险较高的患者，如患有严重息肉病的患者以及在计算机断层扫描成像中额窦开口小于4毫米的患者，可能需要进行初次DrafⅢ手术。DrafⅢ手术的其他适应证包括用于肿瘤切除以及修复额窦的创伤性骨折。当额隐窝前后径足够宽以便器械进入时（通常大于4 - 5毫米），“由内向外”的DrafⅢ手术是标准方法。当额隐窝过窄以至于无法安全容纳器械时，可以进行“由外向内”的DrafⅢ手术。应定期进行清创随访以防止新造口狭窄。
