Endoscopic Direct "Draf IIa" (Carolyn's Window Approach) Versus Endoscopic Angled "Draf IIa"Approach in Chronic Rhinosinusitis With Frontal Sinus Affection ( A Comparative Study ).

NCT ID: NCT06668844

Last Updated: 2024-10-31

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Clinical Phase

NA

Total Enrollment

68 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-01-01

Study Completion Date

2028-03-01

Brief Summary

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Patients with chronic rhinosinusitis with frontal sinus affection indicated for sinuscopy will be randomly categorized in 2 groups: group A will have endoscopic directDraf IIa frontal sinusotomy and group B will have endoscopic angled Draf IIa frontal sinusotomy, the two groups will be compared according to ostium patency and perioperative morbidity

Detailed Description

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Frontal sinus surgery is a challenging component of endoscopic sinus surgery due to the intricacy and variability of frontal recess and sinus anatomy. Before the introduction of endoscopy in sinus surgery, complex cases of the frontal sinus were managed through the anterior wall using an osteoplastic flap approach. This technique was relatively successful in treating frontal sinus pathologies, but was invasive with adverse effects and failure in 6-25 percent of patients.

Different endoscopic techniques have been introduced for performing frontal sinusotomy. Draf categorized them into four techniques (Draf I, Draf IIa, Draf IIb, Draf III). Draf II procedures widen the frontal sinus outflow tract from the lamina papyracea laterally to the middle turbinate (Draf IIa) or the nasal septum medially (Draf IIb).

The thickness of the nasofrontal beak, and a limited anterior-posterior dimension of the frontal recess, make the Draf IIa frontal sinus surgery with angled endoscopy and instrumentation visually diffcult and requires skilled dexterity.

The direct access or Carolyn's window approach to the frontal recess replicates Draf's technique via the endoscopic approach. The approach utilizes only the 0° endoscope. In this approach, the entire frontal process of the maxilla, agger nasi and nasal process of the frontal bone, is removed with a high-speed drill.The goal of the approach is to visualize all walls of the frontal sinus via a ° endoscope. This postoperative view predicts better irrigation access and drainage of the frontal sinuses.

Conditions

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Chronic Rhinosinusitis (CRS) Frontal Sinusitis Draf I or IIa Functional Endoscopic Sinus Surgery (FESS)

Keywords

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Frontal sinusitis Direct Draf Endoscopic sinus surgery

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Investigators Outcome Assessors

Study Groups

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First arm

Endoscopic direct Draf IIa (Carolyn' window approach) frontal sinusotomy

Group Type EXPERIMENTAL

Endoscopic direct Draf IIa

Intervention Type PROCEDURE

Endoscopic direct Draf IIa (Carolyn' window approach) frontal sinusotomy

Second arm

Endoscopic angled Draf IIa frontal sinuaotomy

Group Type ACTIVE_COMPARATOR

Endoscopic angled Draf IIa

Intervention Type PROCEDURE

Group BFrontal sinusotomy using angled endoscopeand instruments

Interventions

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Endoscopic direct Draf IIa

Endoscopic direct Draf IIa (Carolyn' window approach) frontal sinusotomy

Intervention Type PROCEDURE

Endoscopic angled Draf IIa

Group BFrontal sinusotomy using angled endoscopeand instruments

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

1. Adult patients (aged 18 and above) with chronic rhino sinusitis affecting the frontal sinus with or without nasal polyps confirmed by nasal endoscopy and CT scan.
2. Unilateral or bilateral cases.
3. Denovo or recurrent cases.

Exclusion Criteria

1. Individuals younger than 18 year-old.
2. Neoplasms
Minimum Eligible Age

18 Years

Maximum Eligible Age

60 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Assiut University

OTHER

Sponsor Role lead

Responsible Party

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Hazem Gamal Noreldein

Assistant Lecturer

Responsibility Role PRINCIPAL_INVESTIGATOR

Central Contacts

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Hazem Gamal Noreldin, Assistant lecturer

Role: CONTACT

Phone: 01024806122

Email: [email protected]

References

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Barham HP, Hall CA, Hernandez SC, Zylicz HE, Stevenson MM, Zito BA, Harvey RJ. Impact of Draf III, Draf IIb, and Draf IIa frontal sinus surgery on nasal irrigation distribution. Int Forum Allergy Rhinol. 2020 Jan;10(1):49-52. doi: 10.1002/alr.22447. Epub 2019 Dec 11.

Reference Type BACKGROUND
PMID: 31826329 (View on PubMed)

Spielman DB, Kim M, Overdevest J, Gudis DA. Zero-Degree Endoscopic Visualization of the Frontal Sinus Predicts Improved Topical Irrigation Delivery. Laryngoscope. 2021 Feb;131(2):250-254. doi: 10.1002/lary.28654. Epub 2020 Apr 11.

Reference Type BACKGROUND
PMID: 32277702 (View on PubMed)

Seresirikachorn K, Sit A, Png LH, Kalish L, Campbell RG, Alvarado R, Harvey RJ. Carolyn's Window Approach to Unilateral Frontal Sinus Surgery. Laryngoscope. 2023 Oct;133(10):2496-2501. doi: 10.1002/lary.30569. Epub 2023 Jan 18.

Reference Type BACKGROUND
PMID: 36651461 (View on PubMed)

Weber R, Draf W, Kratzsch B, Hosemann W, Schaefer SD. Modern concepts of frontal sinus surgery. Laryngoscope. 2001 Jan;111(1):137-46. doi: 10.1097/00005537-200101000-00024.

Reference Type BACKGROUND
PMID: 11192882 (View on PubMed)

Hajbeygi M, Nadjafi A, Amali A, Saedi B, Sadrehosseini SM. Frontal Sinus Patency after Extended Frontal Sinusotomy Type III. Iran J Otorhinolaryngol. 2016 Sep;28(88):337-343.

Reference Type BACKGROUND
PMID: 27738610 (View on PubMed)

Pagella F, Maiorano E, Turri-Zanoni M, Ferrari M, Carena P, Zoia C, Czaczkes C, Conti C, Schreiber A, Battaglia P, Emanuelli E, Pelucchi S, Bignami M, Nicolai P, Castelnuovo P. The role of the osteoplastic flap in the endoscopic era: a retrospective multicentre experience on revision surgery. Acta Otorhinolaryngol Ital. 2023 Apr;43(Suppl. 1):S34-S40. doi: 10.14639/0392-100X-suppl.1-43-2023-04.

Reference Type BACKGROUND
PMID: 37698098 (View on PubMed)

Wormald PJ, Bassiouni A, Callejas CA, Kennedy DW, Citardi MJ, Smith TL, Orlandi RR, Kaschke O, Siow JK, Szczygielski K, Lund V, Fokkens W, Psaltis AJ. The International Classification of the radiological Complexity (ICC) of frontal recess and frontal sinus. Int Forum Allergy Rhinol. 2017 Apr;7(4):332-337. doi: 10.1002/alr.21893. Epub 2016 Dec 5.

Reference Type BACKGROUND
PMID: 27918154 (View on PubMed)

Other Identifiers

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Endoscopic direct Draf IIa

Identifier Type: -

Identifier Source: org_study_id