Role of frontal sinus surgery in nasal polyp recurrence.
OBJECTIVE
Patients with aggressive nasal polyp recurrence form an important subgroup of patients with refractory sinus disease. The objectives of this study were to establish patterns of polyp recurrence and evaluate the effect of frontal sinus surgery (Draf 2a vs. Draf 3) on polyp recurrence.


METHODS
Retrospective cohort study reviewing 338 consecutive operations.


METHODS
Polyp recurrence was defined according to the Lund-Kennedy mucosal edema score. Survival analysis methods were used for statistics.


RESULTS
After complete sphenoethmoidectomies, Draf 2a frontal sinusotomies, and middle meatal antrostomies persistent polyp recurrence occurred in 19.8% of patients after 6 months and increased to 22.7% of patients after 12 months. Polyps first recurred in the area of the frontal sinus/ostium (55%) followed by the ethmoids (38%). Asthma and aspirin sensitivity were the most important variables affecting recurrence (hazard ratios, 1.71, 1.79, respectively; P < .05) The Draf 3 procedure was a significant factor in reducing recurrence, especially in asthma and aspirin intolerant patients. The overall revision rate was 18% (follow-up duration >12 months, median = 29 months), with a 37% revision rate in the FESS group versus 7% in the Draf 3 group (P < .001). Survival analysis showed that the Draf 3 significantly reduced the risk of revision (hazard ratio = 0.258, P = .0026).


CONCLUSIONS
Nasal polyposis is characterized by a high rate of recurrence. The presence of asthma or aspirin intolerance leads to more aggressive recurrence, and in these patients the Draf 3 drillout procedure becomes a good option for improved long-term outcomes and reducing the need for revision surgery.
Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia.
Ahmed
A
Bassiouni
Peter-John
PJ
Wormald
D001249:Asthma / Q000601:surgery; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D005626:Frontal Sinus / Q000601:surgery*; D015522:Frontal Sinusitis / Q000150:complications* / Q000601:surgery; D006801:Humans; D008297:Male; D009298:Nasal Polyps / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012220:Rhinitis / Q000150:complications* / Q000601:surgery; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome