PDF(Pubmed)
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.
摘要：
额窦内侧引流-DrafIII型（改良内窥镜Lothrop）手术，在过去的三十年里，已经成为额窦手术的基石。尽管它被广泛接受,再狭窄和新口关闭等挑战仍然存在，促使人们探索各种预防技术。在这项回顾性研究中,我们分析了2015年11月至2023年11月接受DrafIII手术的111例患者的数据,平均随访期为3年11个月.大约三分之二的患者（64％）以前接受过鼻窦手术，16％以前接受过DrafIII。超过一半的患者有炎症，大多数是慢性鼻窦炎伴鼻息肉（CRSwNP）（46％），15%的人被诊断为恶性鼻窦肿瘤，23%患有良性鼻窦肿瘤，其中最常见的是骨瘤，占14例。平均随访时间为3年11个月。我们专注于评估黏膜瓣和游离移植物在预防新孔闭合方面的功效。尽管皮瓣使用与需要翻修手术或口通畅维持之间似乎没有统计学上的显着相关性，亚组分析强调了皮瓣重建对慢性鼻-鼻窦炎伴鼻息肉患者的益处.在这个子群中,使用皮瓣或移植物可将新口狭窄率从20％降低至0％（p<0.05）。总体翻修率为11.7％-然而，在手术时没有急性炎症的患者中，这一比例为8％，而在额隐窝存在脓液的情况下，这一比例上升到31％（p=0.02）。这项研究通过提供对长期结果的见解，为现有文献做出了贡献。额窦手术干预的持久有效性，尤其是在评估长期结果时考虑潜在病理的重要性。
