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Draf III in the Acute Phase of Pott's Puffy Tumor: A Scoping Review
Sahil Kakar1, Haris Ali2, Husnaa Fathima Ali Azamathullah Khan3
1Department of ENT and Skull Base Surgery, Queen Elizabeth Hospital Birmingham University Hospitals Birmingham Foundation Trust Birmingham UK.
Background:
Pott's puffy tumor (PPT) is a rare but serious sequela of frontal sinusitis characterized by osteomyelitis of the frontal bone with subperiosteal abscess formation. Surgical management has traditionally been delayed until resolution of the acute infection. This scoping review evaluates the safety and outcomes of performing "Hot" Draf III (modified Lothrop) surgery during the acute phase of PPT.
Methods:
A review was conducted in accordance with PRISMA guidelines. Literature searches were performed across PubMed, Embase, Scopus, and ClinicalTrials.gov without date restriction. Eligible studies included patients undergoing Draf III surgery acutely (within 28 days of presentation) for PPT. Data were extracted on demographics, surgical approach, complications, and reintervention rates. Pooled analysis was performed using a random-effects model with Freeman-Tukey transformation to stabilize variance.
Results:
Five studies met the inclusion criteria, encompassing nine patients (seven males, two females; mean age 50.3 years). All underwent acute Draf III surgery, primarily via endoscopic approaches (88.9%). Meta-analysis demonstrated a pooled complication rate of 0% (95% CI: 0%-40%) and a reintervention rate of 3% (95% CI: 0%-71%), with no significant heterogeneity (I² = 0%).
Conclusion:
"Hot" Draf III surgery appears to be a safe and effective management option for PPT during the acute phase, offering low complication and reintervention rates. While these findings support early surgical intervention, larger, prospective studies are required to validate long-term outcomes and define patient selection criteria.
Insights
Early "Hot" Draf III surgery for Pott's puffy tumor (PPT) is safe and effective. This approach for frontal sinusitis complications shows low complication and reintervention rates, supporting prompt surgical intervention.
Area of Science:
- Otolaryngology
- Neurosurgery
- Infectious Disease
Background:
- Pott's puffy tumor (PPT) is a severe complication of frontal sinusitis, involving frontal bone osteomyelitis and subperiosteal abscess.
- Traditional management delays surgery until acute infection resolves.
- This review examines the safety and outcomes of acute
- Hot
- Draf III (modified Lothrop) surgery for PPT.
Purpose of the Study:
- To evaluate the safety and efficacy of performing
- Hot
- Draf III surgery during the acute phase of Pott's puffy tumor.
- To assess complication and reintervention rates associated with acute Draf III surgery for PPT.
Main Methods:
- A scoping review adhering to PRISMA guidelines was conducted.
- Literature searches included PubMed, Embase, Scopus, and ClinicalTrials.gov.
- Eligible studies involved patients undergoing acute Draf III surgery (within 28 days) for PPT, with pooled analysis of extracted data.
Main Results:
- Five studies with nine patients met inclusion criteria; most underwent endoscopic Draf III surgery.
- Pooled analysis showed a 0% complication rate (95% CI: 0%-40%) and a 3% reintervention rate (95% CI: 0%-71%).
- No significant heterogeneity was observed (I² = 0%).
Conclusions:
- Acute
- Hot
- Draf III surgery appears safe and effective for managing Pott's puffy tumor.
- Low complication and reintervention rates support early surgical intervention.
- Larger prospective studies are needed to confirm long-term outcomes and refine patient selection.
