Comparative restenosis and revision rates of draf IIB versus draf III frontal sinusotomy in chronic rhinosinusitis: a meta-analysis stratified by endotype
Shahid, Muhammad Sohaib Naeem, Naimal Lone, Muhammad Danish Adnan, Umer Khurram, Muhammad Mahad Hirayama, Yuri Iftikhar, Haissan
Shahid, Muhammad Sohaib
Naeem, Naimal
Lone, Muhammad Danish
Adnan, Umer
Khurram, Muhammad Mahad
Hirayama, Yuri
Iftikhar, Haissan
Abstract
BackgroundNo 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.MethodsFollowing 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.ResultsThirty-eight studies met inclusion criteria (restenosis = 1550; revision = 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.ConclusionsDraf 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 strategies.
MIDER Authors
Affiliations
Date
2026-06-16
Type
Article
Citation
Shahid MS, Naeem N, Lone MD, Adnan U, Khurram MM, Hirayama Y, Iftikhar H. Comparative Restenosis and Revision Rates of Draf IIB Versus Draf III Frontal Sinusotomy in Chronic Rhinosinusitis: A Meta-Analysis Stratified by Endotype. Am J Rhinol Allergy. 2026 Jun 16:19458924261456359. doi: 10.1177/19458924261456359. Epub ahead of print.