Comparative restenosis and revision rates of Draf IIB versus Draf III frontal sinusotomy in chronic rhinosinusitis: A meta-analysis stratified by endotype

Document Type

Review Article

Department

Medical College Pakistan

Abstract

Background: No prior meta-analysis has directly compared restenosis or revision rates between Draf IIb and Draf III in chronic rhinosinusitis (CRS) or evaluated how Type 2 versus non-Type 2 endotypes influence these outcomes.
Methods: Following PRISMA guidelines, PubMed, MEDLINE, Embase, and ClinicalTrials.gov were searched on 5 January 2025 for studies reporting restenosis or revision after Draf IIb or Draf III in adults with CRS. Random-effects meta-analyses of proportions (Freeman-Tukey transformation; Hartung-Knapp CIs), pooled restenosis and revision rates, with subgroup analyses by procedure type and endotype.
Results: Thirty-eight studies met inclusion criteria (restenosis n = 1550; revision n = 1305). The pooled restenosis proportion across procedures was 9% (95% CI: 5-14%) and the pooled revision proportion was 9% (95% CI: 5-13%). Restenosis was lower after Draf IIb than Draf III (0.8% vs. 12%), with revision rates showing a similar pattern (2% vs. 10%). Type 2 CRS demonstrated higher pooled rates of restenosis (8% vs. 1%) and revision (12% vs. 3%) compared with non-Type 2 CRS.
Conclusions: Draf IIb is associated with lower pooled restenosis and revision rates than Draf III in CRS. Type 2 inflammatory endotype confers substantially higher risk of adverse frontal sinus outcomes. Incorporating endotype into procedural decision-making may improve prognosis. Prospective, endotype-stratified studies are needed to refine indications for Draf IIb versus Draf III and optimize adjunctive management strategie

Comments

Volume, issue, and pagination are not provided by the author/publisher.

Publication (Name of Journal)

American Journal of Rhinology & Allergy

DOI

10.1177/19458924261456359

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