Articles Vol. 67 No. 9 25/09/2026

OUTCOMES OF ENDOSCOPIC DRAF III FRONTAL SINUS SURGERY USING THE OUTSIDE-IN APPROACH

Nguyen Quang Tu, Tran Viet Luan
DOI: 10.52163/yhc.v67i9.6642
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Abstract

Objective: To evaluate the outcomes of endoscopic Draf III frontal sinus surgery using the outside-in approach.

Materials and Methods: A prospective case series was conducted in 35 patients who underwent endoscopic Draf III frontal sinus surgery using the outside-in technique at Ho Chi Minh City ENT Hospital between January 2022 and December 2025.

Results: The mean age was 45.3 ± 12.3 years, and 60% of patients were male. Previous sinonasal surgery had been performed in 60% of cases. Indications included frontal mucocele (45.7%), recurrent frontal sinusitis (25.7%), osteoma (20.0%), and inverted papilloma (8.6%). Mean operative time was 265.4 ± 89.6 minutes, with a median estimated blood loss of 300 mL (IQR, 200–400 mL). No intraoperative complications occurred. Median SNOT-22 scores improved significantly from 36 (IQR, 33.5–41) preoperatively to 4 (IQR, 3–5) at 6 months postoperatively (p < 0.001). At 6 months, a wide and patent frontal neo-ostium was observed in 91.4% (32/35) of patients. Postoperative CT demonstrated frontal sinus patency in all patients, with no evidence of disease recurrence during follow-up.

Conclusion: In this single-arm case series, endoscopic Draf III frontal sinus surgery using the outside-in approach showed favorable short-term outcomes, with a high rate of neo-ostium patency and marked improvement in SNOT-22 scores. Given the small sample, the absence of a comparison group, and the limited follow-up (median, 12.2 months), these findings should be interpreted with caution and confirmed by larger, controlled studies with longer follow-up.

Keywords
Draf III, modified endoscopic Lothrop procedure, frontal sinus, endoscopic sinus surgery, outside-in technique, mucosal flap.
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