From the Guidelines
Draf procedures for frontal sinus surgery include Draf IIa and Draf III.
Types of Draf Procedures
- Draf IIa: involves a complete sinus opening including anterior and posterior ethmoidectomy, middle meatal antrostomies, sphenoidotomy, and frontal opening 1
- Draf III: also known as extended endoscopic surgery, which could also include a more extensive opening of the frontal sinus 1
Rationale for Draf Procedures
The goal of these procedures is to create a sinus cavity that incorporates the natural ostium, allows adequate sinus ventilation, facilitates mucociliary clearance, and facilitates instillation of topical therapies 1.
Alternative Surgical Approaches
Other surgical approaches, such as frontal sinus trephine and postoperative irrigation, or frontal sinus obliteration with fat, may be considered in certain cases, such as acute or chronic frontal sinusitis, or when endoscopic surgical techniques fail to resolve chronic frontal sinusitis 1.
From the Research
Draf Procedures for Frontal Sinus Surgery
The Draf procedures are a set of surgical techniques used to treat frontal sinusitis. These procedures include:
- Draf IIb: a unilateral drainage procedure from orbit to septum 2
- Draf IIc: an extension of the Draf IIb procedure, which crosses the midline without including the opposite frontal recess 2
- Draf III: a procedure that provides a common median drainage pathway for bilateral frontal sinuses from orbit to orbit 2, 3, 4
Characteristics of Each Procedure
- Draf IIb: provides unilateral drainage and may be advantageous in cases where inclusion of the nasal and frontal sinus septum is beneficial without extension to the opposite frontal recess 2
- Draf IIc: extends the Draf IIb procedure across the midline, allowing for drainage with reduced manipulation of the uninvolved side 2
- Draf III: also known as the modified endoscopic Lothrop procedure, it is a more extensive procedure that provides a common median drainage pathway for bilateral frontal sinuses 3, 4
Outcomes and Comparisons
- A study comparing Draf 2B and Draf 3 procedures found that both procedures offer durable symptomatic improvement for patients with refractory frontal chronic rhinosinusitis (CRS), with no significant differences in patency, revision rates, or complications 5
- Another study found that the Draf III procedure is safe and effective for patients who have failed conventional frontal sinus procedures, with a significant improvement in symptoms and a low rate of major complications 4