Bilateral Frontal Sinus and Epidural Mucopyocele Drainage Using "Modified" Draf III

Shahrokh Khoshsirat; Mohammad Samadian; Afsoon Zandi; Ilia Mirzaei; Seyed Taher Mousavian

doi:10.1155/crot/7636938

Bilateral Frontal Sinus and Epidural Mucopyocele Drainage Using "Modified" Draf III

Case Rep Otolaryngol. 2025 Sep 4:2025:7636938. doi: 10.1155/crot/7636938. eCollection 2025.

Authors

Shahrokh Khoshsirat^{1

2}, Mohammad Samadian³, Afsoon Zandi⁴, Ilia Mirzaei^{5

6}, Seyed Taher Mousavian¹

Affiliations

¹ Department of Otolaryngology, Head and Neck Surgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
² Department of Otolaryngology, Hearing Disorders Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
³ Department of Neurosurgery, Skull Base Research Center, Loghman Hakim Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
⁴ Department of Otorhinolaryngology, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
⁵ Neurosurgery Department, Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
⁶ Hearing Disorders Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Abstract

Introduction: Draf III is a surgical technique which uses endoscopic approach to access the frontal sinus, by leaving almost no skin markings and having minimal side effects. The technique is most frequently indicated for frontal chronic refractory sinusitis, followed by mucoceles and skull base or paranasal tumors. The aim of Draf III is to drain frontal sinus masses and collections. Clinical Presentation: In this report, we present a 16-year-old male with progressive headaches, dizziness, nausea, and vomiting whose imaging revealed left-predominant bilateral frontal epidural mucocele and abscess. A Draf III approach was chosen, to which bilateral supraorbital trephinations were added for better drainage of the collection. Mucosal grafts were used to avoid crusting and stenosis. Post-operation included a course of antibiotics and steroids with three sessions. On the twelfth-month follow-up, the patient was doing well and had no complaints. Conclusion: A modified Draf III approach is effective for the management of bilateral frontal mucopyocele in treatment-resistant cases, without causing any major complications.

Keywords: Draf III; frontal epidural abscess; mucopyocele drainage; trephination.

Publication types

Case Reports