Long-Term Outcome of Frontal Sinus Surgery Using the Draf Procedure

Purpose: The aim of the study was to evaluate the long-term outcome of frontal sinus surgery using Draf II and III procedures for chronic frontal sinusitis or frontal mucocele.

Materials and Methods: The retrospective study reviewed all consecutive patients operated on with Draf II or III procedure between 1996 and 2005 for whom a follow-up of at least 1 year was obtained. Inclusion criteria were a failure of a previous ethmoidectomy with persistent disease. Patients with diffuse neo-osteogenesis or lateral seated mucocele were excluded and treated by osteoplastic flap obliteration. The following data were recorded: pre- and postoperative symptoms and endoscopic examination, surgical procedure, and CT scan.

Results: Forty-three patients completed the inclusion criteria. They were operated by Draf procedure (20% Draf II and 80% Draf III) for frontal mucocele (n = 23) or chronic frontal sinusitis (n = 20). Anatomical success (patency of the new ostium) was obtained in 89.5%, 76.3%, and 76.3% at 1, 2, and 5 years, respectively. Functional success (absence of recurrence of the frontal sinus disorder) was obtained in 83.7%, 75.6%, and 67.2% at 1, 2, and 5 years. Success was significantly higher after Draf III than after Draf II. Mucosal disorder, stent of the new ostium, and use of a navigation system did not have significant influence on the final outcome.

Conclusion: Draf III is a useful and safe procedure, with a high rate of success for frontal sinus disorder.