Comparative analysis of endoscopic sinus surgery draf procedures in patients diagnosed as chronic rhinosinusitis with nasal polyps

COMPARATIVE ANALYSIS OF ENDOSCOPIC SINUS SURGERY DRAF PROCEDURES IN PATIENTS DIAGNOSED AS CHRONIC RHINOSINUSITIS WITH NASAL POLYPS Objective: In our study, we aimed to find preoperative and postoperative clinical, radiological and endoscopic differences between patients with nasal polyp chronic rhinosinusitis who underwent endoscopic frontal sinus surgery procedures Draf 3 and Draf 2a. Materials and Methods: Patients who were included in study were; admitted to Karadeniz Technical University Farabi Hospital between January 2022 and December 2022, over the age of 18, diagnosed with bilateral NPCRS, underwent frontal sinus surgery and received medical treatment before surgery. It was planned to divide the patients into two groups according to the order of arrival, using a simple randomization scheme, to be administered Draf 3 and Draf 2a. Sinonasal Outcome Test-22 (Question 12 for olfaction was also evaluated under a separate heading) was applied to the patients before surgery, at the 2nd week, 1st month, 3rd month and 6th month after surgery. Perioperative Sinus Endoscopy (POSE) scoring was applied at the 2nd week, 1st month, 3rd month and 6th month at postoperative period of endoscopy. Paranasal sinus tomography taken preoperatively and at the 6th month postoperatively was evaluated with Lund-Mackay scoring. In addition, the patients were recorded in terms of perioperative complications and postoperative endoscopic polyp recurrence. Results: The mean age of the patients included in the study was 48.3±17.5 for Draf 2a (n=22) group and 44.1±17.08 for Draf 3(n=20) group respectively. Patients who underwent Draf 3 procedure had higher preoperative Snot-22 scores (p=0.301) and Lund-Mackay score (p=0.484) compared to patients in Draf 2a group. As a result of our study, improvement in symptoms, increase in quality of life, improvement in endoscopic examination and decrease in Lund-Mackay scores were achieved in both groups, but the improvement was more obvious in Draf 3 group. Polyp recurrence was more common in the Draf 2a group, patients with asthma and aspirin intolerance. Complications were observed more in the Draf 3 group and in patients with a previous history of endoscopic sinus surgery. Conclusion: Draf 3 endoscopic frontal surgery procedure; It may be a good option for patients with a previous history of endoscopic sinus surgey, asthma and/or aspirin intolerance, with a higher disease burden, to improve quality of life and reduce the risk of polyp recurrence. Key Words: Nasal polyposis, Frontal sinus surgery, Draf 3 procedure, Draf 2a procedure, SNOT-22 questionnaire.