Abstract

Objective: Recent developments in sinus endoscopy promote the surgical treatment of frontal sinus diseases. Due to limited experience in Draf-III endoscopic surgery in Iran, this study was designed to evaluate Draf-III indications and their correlation with changes in symptom severity two years after surgery. Materials and Methods: In this historical cohort study, patients who had undergone Draf-III surgery in Amir Alam and Emam Khomeini Hospitals in 2012-2013 with any indication were enrolled. Draf-III indications, complaints before surgery, and the Sino-Nasal Outcome Test (SNOT-22) symptom severity score before and after surgery were evaluated. Patients were evaluated two years after surgery, and then, the changes in symptoms severity and correlated factors were evaluated. Results: Thirty-three patients with a mean age of 37.06 years were evaluated. The symptoms severity score. Draf-III indications were fungal sinusitis in 24.2 of patients, frontal osteoma in 9.1, resistant polyposis in 45.5, recurrence after previous surgery in 21.2, frontal mucocele in 27.3, and pneumatocele in 3. Decreasing the symptoms severity score were significantly less in patients with fungal sinusitis as a Draf-III indication (14.37 vs 24.2, p=0.001). The changes in symptoms severity score were significantly greater in patients with resistant polyposis (26.4 vs 18.11, p=0.001) and a recurrence after previous surgery (28.29 vs 20.15, p=0.011). There was also a significant correlation between age and symptom release (p=0.042, r=0.367). Conclusion: Resistant polyposis was the most prevalent indication of Draf-III surgery. Draf-III was more useful for patients with resistant polyposis with recurrence after previous surgery and for older patients, but patients with fungal sinusitis as a Draf-III indication had less symptom severity reduction. Other studies with a larger sample size and longer follow-up duration are needed to further evaluate the efficacy of Draf-III in various indications and conditions.