Frontal sinusotomy: Draf III

The common frontal sinusotomy, Draf III, or modified endoscopic Lothrop procedure is an important surgical approach that has numerous indications in endoscopic sinus and anterior skull base surgery. The most common application for the common frontal sinusotomy is in the management of chronic inflammatory sinus disease since it improves topical access to the frontal sinus. Another function of the Draf III is to increase surgical access to the frontal sinus and anterior skull base. This allows surgeons to endoscopically address many pathologies involving the frontal sinus and aids in ventral skull base resections and reconstructions. The procedure removes the nasofrontal beak and frontal sinus floor converting the complex and often confined anatomy of the frontal recess and sinus into a unified simple cavity. Modifications to the technique, namely the outside-in approach, and advances in endoscopic technology and instrumentation have increased surgical efficiency and improved healing following the procedure.