Nasal allergy causes polyps. Drugs can control allergy, but cannot eliminate the polyps already formed. FESS (Functional Endoscopic Sinus Surgery) is commonly done in the above condition.
In the event of recurrence or extensive polyps, especially associated with fungal sinusitis, full house FESS with a Modified LOTHROP Procedure (Draf3) needs to be done.
Comparing results of Functional Endoscopic Sinus Surgery and a Modified Lothrop Procedure (Draf 3) in recurrent polyps, & fungal sinusitis
In FESS surgery, pus, fungus and polyps are removed and the sinus orifices are opened. This methodology has some limitations. Douche (mixture of saline and steroids ) and spray which are supposed to be used lifelong after surgery, cannot reach all the corners of all the sinuses especially the frontal sinus. So these medical applications can control the disease only to a certain extent in a person undergoing FESS.
A new surgical procedure has been developed for recurrent polyps, and fungal sinusitis . This surgery is total sphenoethmoidectomy with Draf 3 ( Modified Lothrop procedure).This was first described by the late Prof. Wolfgang Draf
By this surgery, sinus orifices are opened widely, so that the disease is removed to the very last bit and nasal washes with drugs can reach all corners of the sinuses . Thus the polyps, and the fungus resulting from allergy are effectively controlled.
Since the frontal sinus is surrounded by bones,the brain, the eyes and soft tissues, the technique has to be very precise. If along with the frontal sinus, the ethmoid and sphenoid sinuses which lie in between, and behind the eyes are opened up widely, it is called a full house sphenoethmoidectomy.
There are not many centres doing Draf3 in our country.
In the more commonly done FESS, liquid drugs cannot reach the far interiors of the frontal sinus, since the openings which are made are less than 4 mm ( which is the minimum dimension needed for fluids to penetrate). But in Draf3, the medicinal washes can reach further through the wider opening made by drilling the bones.
The chance of recurrence (getting it back again) in FESS is almost 100 % whereas in Draf3 , it is only 25 % .
By this new technique, revolutionary changes have been brought about in the management of RECURRENT nasal polyps, & fungal sinusitis, which has been a vexing issue ( having to redo the operation again & again) not only to the suffering patient but also the treating surgeon.