Role of frontal sinus surgery in nasal polyp recurrence

TLDR

Aggressive nasal polyp recurrence constitutes a significant subgroup of refractory sinus disease. The study aimed to characterize recurrence patterns and assess the impact of Draf 2a versus Draf 3 frontal sinus surgery on recurrence. A retrospective cohort of 338 operations was analyzed using survival analysis to evaluate recurrence after sphenoethmoidectomy, Draf 2a, and middle meatal antrostomy. Recurrence occurred in 19.8 % at 6 months and 22.7 % at 12 months, most often in the frontal sinus (55 %) and ethmoids (38 %); asthma and aspirin sensitivity increased risk (HR 1.71–1.79), while Draf 3 significantly lowered recurrence and revision rates (overall 18 %, 7 % vs.

Abstract

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.Retrospective cohort study reviewing 338 consecutive operations.Polyp recurrence was defined according to the Lund-Kennedy mucosal edema score. Survival analysis methods were used for statistics.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).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.