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

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.