Optimizing Draf III Frontal Sinusotomy: Anatomical Planning, Neo-Ostium Preservation, and Prevention of Surgical Failure

Abstract

Background: Draf III frontal sinusotomy, or the endoscopic modified Lothrop procedure, creates a common drainagepathway between both frontal sinuses and the nasal cavity. Although it provides extensive access and facilitates topicaltherapy, its long-term success is threatened by neo-ostium stenosis, recurrent polyposis, osteoneogenesis, residualobstructing cells, and persistent inflammatory disease. Surgical failure is rarely attributable to one factor alone; it usuallyreflects an interaction among unfavorable anatomy, incomplete dissection, excessive mucosal injury, insufficient neo ostium dimensions, and inadequate postoperative disease control.