Enhancing Frontal Sinus Surgery: Assessing the Long-Term Impact of Free Grafts and Flaps in Draf III Procedures

Author:

Leventi Argyro1,Chatzinakis Vasileios1ORCID,Papargyriou Georgia Evangelia1,Georgalas Christos12ORCID

Affiliation:

1. Endoscopic Skull Base Centre Athens, Hygeia Hospital, 151 23 Athens, Greece

2. Medical School, University of Nicosia, Nicosia 2408, Cyprus

Abstract

The frontal sinus medial drainage —Draf Type III (modified endoscopic Lothrop) procedure, has become a cornerstone in frontal sinus surgery over the last three decades. Despite its widespread acceptance, challenges such as restenosis and neo-ostium closure persist, prompting the exploration of various preventive techniques. In this retrospective study, we analyzed data from 111 patients who underwent the Draf III procedure between November 2015 and November 2023, with a mean follow-up period of 3 years and 11 months. Approximately two-thirds of patients (64%) had undergone previous sinus surgery and 16% a previous Draf III. Over half of the patients had inflammatory conditions, with the majority being chronic rhinosinusitis with nasal polyps (CRSwNP) (46%), while 15% were diagnosed with malignant sinonasal tumors, and 23% with benign sinonasal tumors, of which the commonest was osteoma, accounting for 14 cases. The mean follow-up period was 3 years and 11 months. We focused on evaluating the efficacy of mucosal flaps and free grafts in preventing neo-ostium closure. Although it appears that there is no statistically significant correlation between flap usage and the need for revision surgery or ostium patency maintenance overall, subgroup analysis highlighted the benefits of flap reconstruction in patients with chronic rhinosinusitis with nasal polyps. In this subgroup, the use of flaps or grafts reduced the rate of neo-ostium stenosis from 20% to 0% (p < 0.05). Overall revision rate was 11.7%—however this was 8% in patients without acute inflammation at the time of surgery and went up to 31% in the presence of pus in the frontal recess (p = 0.02). This study contributes to the existing literature by providing insights into long-term outcomes, the enduring effectiveness of interventions in frontal sinus surgery, and especially the importance of taking into account the underlying pathology when assessing long-term outcomes.

Publisher

MDPI AG

Reference29 articles.

1. Endonasal micro-endoscopic frontal sinus surgery: The fulda concept;Draf;Oper. Tech. Otolaryngol.-Head Neck Surg.,1991

2. Georgalas, C., and Sama, A. (2022). The Frontal Sinus: Surgical Approaches and Controversies: 614 Illustrations, Thieme.

3. Long terms results of Draf type III (modified endoscopic Lothrop) frontal sinus drainage procedure in 122 patients: A single centre experience;Georgalas;Rhinology,2011

4. What is the evidence for the use of mucosal flaps in Draf III procedures?;Wei;Curr. Opin. Otolaryngol. Head Neck Surg.,2014

5. Frontal Ostium Restenosis After the Endoscopic Modified Lothrop Procedure;Tran;Laryngoscope,2007

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3