Thoughts/Advice on the "Drill Out" (Draf 3) sinus surgery?

T

TheSaltyOne

Guest
Hi guys,

The History:
I have had sinus issues for the past 5 years. I've had the initial big sinus surgery that makes all your sinus passages wider and I've had 3 "clean outs" since then where they go in while you are sedated and they flush/rinse all the crap out. Well of course I'm lucky enough to find out it's rare for CFers to get major "frontal sinus" issues but I am one of the lucky ones. Most of my sinus pain is in my forehead and especially above my eyebrows. They've been hurting like crazy lately and my sinus doctor has recommended I have the Draf 3 surgery performed.

The procedure:
The old way was to take out the frontal sinuses completely by pulling back the forehead (gross) and it was called "Obliteration". Now days he explained that they go in through your nostrils and will drill out some of the frontal bone so that the passages for the frontal sinuses are wider and more open to allow better flow. I've read it is a very careful precise procedure but has great results. I've also had it explained that there is no outside effects as in everything is on the inside and I won't end up looking goofy or anything like that. My main concerns are how dangerous is it and are the rewards greater than the risks?

My Options:
If I were to hold off for now and just get a "clean out" like normal then I could possibly be put on the drug for DF508 in the spring (if it is available) and I've heard it does wonders for sinuses as well. So what do you think? If anyone has had any experiences like these (especially with this particular procedure) please share your thoughts as I'm not sure what to do and need to make a decision in the next few days.

Thanks!
 
G

Gammaw

Super Moderator
Wow. I haven't heard of that kind of surgery before, so I will not pretend I have any applicable experience or advice! My DS has had horrid sinus issues with polyps, which Ive discussed in many threads. Fortunately we have happened upon a good spell which I attribute to some new approaches taken this last time he had surgery for removal of the polyps. What I did notice in your post is the lack of a downside. I'm not suggesting you should do it or that there isnt a downside. But I wonder what the actual risks are, the potential complications, and the long term issues, if any. You didn't mention any. And I'm not even sure what issues your surgeon has identified. I know you have pain and that can certainly be reason enough for surgery. But are you dealing with polyps in the frontal sinuses? Infections? A structural problem? The usual CF cilia don't work to clear out my nose issues? That might get you more information from members that could be helpful. I hope this helps in some small way!
 
T

TheSaltyOne

Guest
So from what i've read and heard there isn't any big downsides. My thing was when I first did the "clean out" I was warned that if anything were to go wrong during surgery that it could be loss of vision, damage to the brain, excessive bleeding, etc, due to how close it is to all of those things. So I was thinking wow if those are the risks with just the "clean out" then I wonder how bad the "drill out" could be. The surgeon himself downplayed it acting like he was pretty confident in the procedure. So that was nice but yet still I would like more opinions than just one surgeon who is confident in himself.

As far as my issues.. yes I have pain everyday there but more importantly it is causing infection to drain to my lungs, in which of course is causing exacerbations. So usually when I get "clean outs" I'm able to stay out of the hospital for much longer periods of time than normal. Due to that, we are contributing a lot of my lung infections to my sinuses.

Just trying to see if anyone has had it, what their experience was, and if there has been any negative side effects from the procedure.
 
G

Gammaw

Super Moderator
We haven't had anything that sounds for certain like what you describe, Salty. But certainly the usual risks of sinus surgery aren't to be ignored. We have had three sinus surgeries on my DS. They have enlarged the sinus spaces each time and removed some bone in the process. So it may be quite similar to what you describe, but without the terminology being used on our end. The ENT has been more aggressive each time until his sinuses are wider than most adults, despite his tender age (9). But this last time they also inserted steroid infused cages to hold the sinuses open and prevent inflammation while healing - the cages dissolved within 45 days. In addition, they cultured the material removed, identified the "bugs" present in his sinuses (which corresponded exactly with the bugs his sputum has cultured), ruled out the presence of any fungus, and then put him on oral antibiotics for the various bugs, AND had him use a sinus atomizer with compounded antibiotics for the same bugs - in effect a topical application of antibiotics directly to the area infected. He goes into the ENT every two months and they check for any accumulated sinus material and suction it out - expressly attempting to do what the average non-CFers sinus cilia do by clearing out irritants, bacteria, etc. I have come to picture it like this: the nasal cilia are designed to capture invaders before they get to your lungs, wash them out with discharge and sneezes. The CFers cilia are clogged with the thick CF mucous instead and it sits there, allowing bugs to sit there and make their way to your lungs. Polyps also seem to be a CFers inflammatory response to this malfunctioning process. Hence the limited success some people have with nasal rinses or neti pots designed to clear out their noses the way nature had intended. Polyps, some say, even help block the lung invasion which would otherwise occur and therefore some patients with chronically and fast recurring polyps have better lung function and fewer complications than they would otherwise. I don't know about that one, but it has been suggested to me by other CFers. In any event, I don't know that any of what I have said is medically sound! It's simply my working - thinking model. My DS won't use a sinus rinse. His ENT even prefers the approach that cleans out his sinuses for him in the ENTs office on a regular basis instead. And so far so good. My little guy has now gone 7 months without a polyp - something he hasn't done since he was a toddler. Before, we had been seeing them grow back huge within 2-3 months instead. I will also say that it doesn't appear to me that the sinus surgeries worked for more than a month or two before his last surgery. Certainly they cleared him out, relieved the pressure, rid him of the polyps, and let him breath easier, and smell things once again. And those surgeries were absolutely necessary. But enlarging the sinuses themselves didn't seem to make much difference in the rate of recurrence. Now, I say that, recognizing full well that I may be wrong - after all, this last surgery had many new variables including more aggressive enlargement as well.
So, I'm afraid I may not have helped much! I suppose if I were nervous or uncertain about it all, I would get a second opinion from another ENT. Someone somewhat progressive to see where else this might all go. Or perhaps do the basics and wait until you feel it's definitely necessary? I am a slow - cautious - decision maker myself. On the other hand, I will say that my little guy has always done well following surgery, which obviously included widening the sinuses and removing bone before. But he does best when hospitalized prior to the surgery long enough to fortify him with antibiotics! We didn't do that last time and it was a much harder and longer recovery. Feel free to ask me any questions and I will do my best. Hopefully someone recognizes the specific procedures you're contemplating and can give you more information.
 
M

MGrossan

New member
Dear Salty one: Sorry about your sinus issue. Some of my CF patients have been able to avoid sinus surgery by using Hydro Pulse pulsatile irrgation with Xylitol added. to the solution. If your doctor will write a prescribption for you and send it to me, I wouuld be pleased to send you a Hydro Pulse unit at no charge in hopes that would clear your problem
Murray Grossan M.D. 8631 W 3rd St Los Angeles Ca 90048 www.grossan.com
 
T

TheSaltyOne

Guest
Wow, thanks so much for the offer! I currently flush my sinuses out with hypertonic saline solution 2-3 times a day. The problem seems to be that there is so much scar tissue, inflammation, etc in my frontal sinuses that the solutions cannot reach them and clear them out. Unlike most CFers that I've heard about, I never get any pain in my cheeks, and only in my frontal sinuses above my eyebrows. So as nice as the offer is I feel like it's not a matter of using the right solution or device but rather finding a way to open the passages better so that the solutions can reach up there.
 
K

kbkbkb

New member
Starting at age 12, I've had many sinus surgeries. So many, I lost count. then, about eleven years ago, my otolaryngologist sent me to a different otolaryngologist in his department who could do a newer type of surgery at the time. The traditional surgery was no longer effective because the multiple surgeries had eliminated any of the usual landmarks in my sinuses. I don't recall it being called a drill out or draf 3, but it sounds like what you describe and I know it involved drilling through bone. Like you, I had been using a hydropulse machine (Waterpik) with saline and later xylitol solution, which helped only to limited degree.

I am now 44 and I am happy I went with this surgery. I haven't had any infections in eleven years. i do get times when my sinuses act up and I go back to using the Waterpik for a few days and it gets better.

I don't remember what the risks involved were exactly, but as I remember, they were the same risks as any sinus surgery and general anesthetic. Following the surgery, I had little pain and recovered quickly.

I don't know if your situation or surgery is exactly the same, but from my experience, it seemed to do the trick.

Good luck to you and I hope all goes well with whatever you decide.
 
T

TheSaltyOne

Guest
Hey kbkbkb, the surgery is also known as the "Modified Lothrop" procedure. But yes it does sound very similar to what you had done. Your results are awesome and I definitely hope thats what happens with me!!!
I went back today for the CT scan and appointment and the doc said my frontal sinuses are completely blocked and he highly suggests the draf 3 surgery. I asked the risks and he went over them briefly and said I don't have to worry about a thing. I also called my ENT from Missouri, where we just came from and he said that the doctor I'm seeing down here is very well known and experienced so I guess I'm going to go through with it. He was extremely confident in the procedure, so fingers crossed.
 
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