The Modified Lothrop Procedure (Draf III Frontal Sinusotomy) in the Management of Frontal Sinus Disease: A Patient Outcomes Study

Objectives/Hypothesis: To assess outcomes in patients who underwent a Draf III frontal sinusotomy procedure for non-malignant frontal sinus disease.

Study Design: Retrospective chart review.

Methods: A chart review and outcomes assessment were performed on a series of patients who underwent a Draf III procedure for benign frontal sinus disease by a single surgeon during the years 2012 to 2015. Outcomes were based on chart review, nasal endoscopy and need for revisional surgery.

Results: A series of 30 patients having undergone a Draf III sinusotomy for frontal sinus disease were identified during the identified time period. Fifty percent had surgery for recurrent chronic frontal sinusitis after failure of one or multiples procedures to the frontal sinus; 16% presented with osteomyelitis of the frontal bone; 10% with intracranial complications of frontal sinus infection; 10% with mucocele; and the remaining 14% of patients presented with trauma, inverted papilloma or cholesterol granuloma. Mean duration of follow-up was 7.1 months with a range from 6 days to 28.5 months. A majority of patients (93%) saw resolution of pre-surgical symptoms. Endoscopic evaluation showed 82%, 14% and 0% for grade 1(widely patent), grade 2(patent but >50% stenosis) and grade 3 (obstructed) respectively. Just one patient required further surgical treatment after the Draf III despite good opening of the frontal sinus outflow postoperatively. It was a patient with frontal osteomyelitis treated first with a Draf III frontal sinusotomy and long-term antibiotics. Finally the patient underwent frontal sinus obliteration with removal of the anterior table for eradication of the infection.

Conclusions: Draf III sinusotomy is an effective treatment choice in the management of complicated frontal sinus disease. It provides long-term patency of frontal sinuses and results in improvement of patient symptoms.