The Draf III mucosal grafting technique: a prospective study.
OBJECTIVE
The Draf III procedure is an advanced surgical option for frontal sinus disease refractory to endoscopic frontal sinusotomy and is used to expose the anterior limit of resection of the skull base during endoscopic management of anterior skull base tumors. Our objective was to evaluate outcomes of a strategy using mucosal grafts to decrease postoperative closure.


METHODS
Prospective cohort.


METHODS
Tertiary care facility.


METHODS
Patients requiring a Draf III procedure were prospectively enrolled in the study. Demographics, reason for the procedure, percentage graft viability, and complications were recorded. The primary outcome measure was anterior-posterior (AP) diameter at 3 months.


RESULTS
Mucosal grafting was performed during 29 Draf III procedures from 2008 to 2011. Twenty-seven patients (average age, 58 years) were available for measurement at 3 months (average postoperative follow-up, 15.4 months; range, 3-30 months). Reasons for the procedure included tumor (n = 14), chronic rhinosinusitis (CRS) with frontal ostium stenosis (n = 12), and trauma (n = 1). Average intraoperative AP diameter was 11.7 mm. All patients met the definition of success (<50% reduction in diameter), maintaining a patent combined frontal sinus ostium for the duration of follow-up (average diameter 10.8 mm at 3 months). Nine patients with CRS and frontal ostium stenosis had openings similar to the entire cohort (>1-year follow-up; average, 19.3 months) with significant symptom reduction (SNOT-22 preop 62.3 ± 20.8 vs 3 months 27.8 ± 14.8 and 1 year 21.4 ± 13.6; P < .0001).


CONCLUSIONS
Cicatricial stenosis and osteoneogenesis are common following the Draf III procedure. This study indicates that the use of mucosal grafts may assist with postoperative stenosis and should be considered a routine strategy for preventing closure.
Department of Surgery/Division of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA.
Bryant T
BT
Conger
Kristen
K
Riley
Bradford A
BA
Woodworth
D003646:Debridement; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005626:Frontal Sinus / Q000293:injuries / Q000601:surgery*; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D009297:Nasal Mucosa / Q000637:transplantation*; D010254:Paranasal Sinus Diseases / Q000601:surgery*; D011446:Prospective Studies; D019291:Skull Base / Q000293:injuries / Q000601:surgery; D016896:Treatment Outcome