Jiang Xiaowen, Zhao Keqing, Zhang Huangkang, Xue Kai, Liu Quan, Gu Ye, Zheng Shixing, Sun Xicai, Yu Hongmeng
Department of Otorhinolaryngology，Eye & ENT Hospital，Fudan University，Shanghai，200031，China.
Department of Neurosurgery，Eye & ENT Hospital，Fudan University.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2024 Aug;38(8):726-731. doi: 10.13201/j.issn.2096-7993.2024.08.010.
Anatomical variation or scar atresia of the drainage channel of the frontal sinus on the affected side, and opening the frontal sinus through the drainage channel of the frontal sinus on the affected side may lead to surgical failure. The purpose of this study is to explore a modified Draf Ⅲ operation to complete the drainage of the affected frontal sinus by removing the floor wall and septum of the frontal sinus and connecting the bilateral frontal sinus through the healthy side of the frontal sinus. Through the anatomical study of 2 skull bone specimens and 2 fresh frozen specimens, the surgical landmark and surgical approach were explored. Four patients with frontal sinus atresia and frontal sinusitis after DrafⅡb surgery in Eye & ENT Hospital of Fudan University were retrospectively analyzed. Descriptive method was used to analyze the data. The bottom wall of bilateral frontal sinus was removed, and the bilateral frontal sinus was enlarged above the nasal septum to form a large common cavity. The uncinate process and ethmoid bubble were retained, and the midline drainage of the affected frontal sinus in the healthy side of the nasal cavity was completed. From August 2022 to April 2023, 4 patients with frontal sinus atresia and frontal sinusitis after DrafⅡb surgery for unilateral frontal sinus papilloma in Eye & ENT Hospital of Fudan University were treated with surgery. The headache symptoms disappeared after surgery, and the drainage of frontal sinus was spacious, the mucosa healed well and the drainage was unobstructed under endoscopy. There were no other postoperative complications. DrafⅢ approach to unilateral frontal sinus for contralateral drainage can drain the affected frontal sinus adequately. The essence of this operation is to drain the bilateral frontal sinus in the unilateral nasal cavity, and this operation has short path, less trauma, and a broader prospect, which is suitable for promotion.
患侧额窦引流通道的解剖变异或瘢痕闭锁，经患侧额窦引流通道开放额窦可能导致手术失败。本研究的目的是探索一种改良的DrafⅢ手术，通过去除额窦底壁和鼻中隔，经额窦健康侧连接双侧额窦，完成患侧额窦的引流。通过对2个颅骨标本和2个新鲜冷冻标本进行解剖学研究，探索手术标志和手术入路。对复旦大学附属眼耳鼻喉科医院4例DrafⅡb术后额窦闭锁伴额窦炎患者进行回顾性分析。采用描述性方法分析数据。切除双侧额窦底壁，在鼻中隔上方扩大双侧额窦形成一个大的共同腔隙，保留钩突和筛泡，完成患侧额窦在鼻腔健康侧的中线引流。2022年8月至2023年4月，复旦大学附属眼耳鼻喉科医院对4例因单侧额窦乳头状瘤行DrafⅡb术后额窦闭锁伴额窦炎患者进行手术治疗。术后头痛症状消失，额窦引流宽敞，黏膜愈合良好，内镜下引流通畅，无其他术后并发症。DrafⅢ入路行单侧额窦对侧引流可充分引流患侧额窦。该手术的本质是在单侧鼻腔内引流双侧额窦，具有路径短、创伤小、前景广阔等优点，适合推广。
