A patient has persistent frontal sinusitis after two operations. CT shows a narrow scarred frontal recess with retained partitions; the frontal sinus remains aerated laterally and there is no tumour. What most strongly determines whether a Draf IIb or Draf III approach is chosen?
Revision frontal surgery is tailored to anatomy and disease rather than operation count alone; a Draf III is justified when unilateral or lesser drainage procedures cannot provide durable access.
A. Patient age alone: Age affects risk but does not define the required frontal drainage corridor.
B. Pattern of disease, drainage anatomy, scarring and the access needed to create a durable common pathway: Revision frontal surgery is tailored to anatomy and disease rather than operation count alone; a Draf III is justified when unilateral or lesser drainage procedures cannot provide durable access.
C. Any previous sinus operation mandates Draf III: Many failures remain amenable to targeted revision; prior surgery alone is not an indication.
D. The Lund–Mackay score alone: A global CT score does not capture frontal recess geometry or operative access.
E. Presence of headache alone: Symptoms require correlation, but headache neither localises obstruction nor selects an operation.
If disease were confined to one accessible frontal recess with favourable anatomy, a targeted Draf IIa or IIb could avoid a drill-out.
Independent Clinora educational material; not official JCIE content, an accredited programme, clinical advice, or a substitute for local policy and specialist judgement.
Back to the Section 1 bank