Draf III mucosal graft technique: long-term results

The Draf III procedure is an effective endoscopic approach to the treatment of frontal sinus disorders, but has a significant restenosis rate. The objective of the current study is to assess long-term success of the Draf III mucosal grafting technique.

Patients undergoing Draf III with mucosal grafting technique were prospectively enrolled. Demographics, indication for surgery, anterior-posterior (AP) diameter of frontal ostium, and complications were recorded. Failure was defined a priori as closure ≥50% of the intraoperative AP diameter at last clinical follow-up.

Ninety-six patients requiring Draf III with mucosal grafting were enrolled, 67 of which (average age 54 years; range, 15-84 years) had at least 1 year of follow-up (average 34 months; range, 12-85 months) and were included in the analysis. Reasons for the procedure included chronic rhinosinusitis with frontal ostium stenosis (n = 37), tumor (n = 26), and cerebrospinal fluid leak (n = 4). Average preoperative Lund-Mackay score was 13.9 ± 7.8. Average intraoperative AP diameter was 11.0 ± 1.9 mm. The procedure was highly effective with 97% (65/67) of patients maintaining a patent frontal sinus ostium (>50% intraoperative AP diameter) for the duration of follow-up (average postoperative diameter 9.9 ± 2.2 mm). However, the 2 Draf III failures remained patent, did not need further intervention, and were considered clinically successful. Three patients required reoperation for reasons unrelated to closure of the Draf III.

Common causes of failure following Draf III procedures include osteoneogenesis and stenosis. This study provides long-term data demonstrating excellent outcomes using the mucosal grafting technique.