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Surgical Approach to the Frontal Sinus with the DRAF 3 Outside-In Technique

DRAF 3 Outside-In

A case of Dr. Juan Maza-Solano

In the SurgSchool surgical training app, one of the most advanced surgical procedures presented is the DRAF 3 Outside-In technique for the approach to the frontal sinus, explained in detail by the Dr. Juan Maza-Solano. This type of intervention is used in complex cases of sinus pathology, such as the presence of mucoceles or fibrotic pathologies that hinder conventional access to the frontal sinus. Below, we review the key points of this technique, as shown in the video available at SurgSchool.

What is the DRAF 3 Outside-In technique?

The technique DRAF 3 is a type of endoscopic nasal surgery that allows wide access to the frontal sinus by resecting part of the bony base of the skull. The Outside-In approach refers to an approach from the outside in, starting with the frontal bone and using critical anatomical references as a guide, such as the first olfactory filament and the nasal branch of the anterior ethmoidal artery.

Key Steps in the DRAF 3 Outside-In Approach

  1. Initial Endoscopic Septoplasty: To improve the visibility of the middle meatus, a septoplasty is first performed. This step is essential to be able to access the frontal sinus area more accurately, especially in patients with complex anatomy or extensive sinus pathology.
  2. Identification of Anatomical References: Dr. Maza-Solano highlights the importance of correctly identifying the first olfactory filament, which is perceived as a resistance. This is located close to the nasal branch of the anterior ethmoidal artery, another key reference during surgery. Knowledge of these structures is essential to avoid complications and preserve the integrity of the skull base.
  3. Careful Milling of the Frontal Bone: Using controlled milling, the frontal bone is weakened to make way for the mucosa of the left frontal sinus. This space is key to treating the pathology located in the right frontal sinus, which in this particular case presents a mucocele.
  4. Septectomy and Unification of the Frontal Sinuses: A septectomy is performed to allow better visualization of the surgical area. The objective is to unite both frontal sinuses, which facilitates access to the pathological area, eliminating the interfrontal barriers with the help of a curved aspirator.
  5. Elimination of Mucoceles and Fibrotic Pathology: Once inside the right frontal sinus, the surgeon removes the blocked mucus, typical of a mucocele. Any remaining fibrotic tissue is then resected, ensuring that both cavities are completely free of pathology.

Final Considerations

A crucial part of this procedure is ensuring that the walls of the frontal sinus are as smooth as possible. Dr. Maza-Solano points out the importance of this detail, as it can influence re-epithelialization and prevent stenosis, a common complication in sinus surgeries. Although some surgeons prefer the use of free grafts to promote healing, in this case a split graft was used to keep the structure open.

Conclusion

The DRAF 3 Outside-In approach is an advanced technique that requires a thorough understanding of nasal and cranial anatomy. Attention to detail and the use of accurate anatomical landmarks are essential for successful surgery and prevention of complications. At SurgSchool, you can view the detailed execution of this procedure, guided by the experience of Dr. Juan Maza-Solano, who offers a clear and practical overview for surgeons in training to understand this complex surgical approach.

To access more surgical cases at this level, DOWNLOAD OUR SURGSCHOOL APP. Improve your surgical skills and stay up to date with the latest techniques and procedures in otolaryngology.

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