Draf III in the Acute Phase of Pott's Puffy Tumor: A Scoping Review.

BACKGROUND

Pott's puffy tumor (PPT) is a rare but serious sequela of frontal sinusitis characterized by osteomyelitis of the frontal bone with subperiosteal abscess formation. Surgical management has traditionally been delayed until resolution of the acute infection. This scoping review evaluates the safety and outcomes of performing "Hot" Draf III (modified Lothrop) surgery during the acute phase of PPT.

METHODS

A review was conducted in accordance with PRISMA guidelines. Literature searches were performed across PubMed, Embase, Scopus, and ClinicalTrials.gov without date restriction. Eligible studies included patients undergoing Draf III surgery acutely (within 28 days of presentation) for PPT. Data were extracted on demographics, surgical approach, complications, and reintervention rates. Pooled analysis was performed using a random-effects model with Freeman-Tukey transformation to stabilize variance.

RESULTS

Five studies met the inclusion criteria, encompassing nine patients (seven males, two females; mean age 50.3 years). All underwent acute Draf III surgery, primarily via endoscopic approaches (88.9%). Meta-analysis demonstrated a pooled complication rate of 0% (95% CI: 0%-40%) and a reintervention rate of 3% (95% CI: 0%-71%), with no significant heterogeneity (I² = 0%).

CONCLUSION

"Hot" Draf III surgery appears to be a safe and effective management option for PPT during the acute phase, offering low complication and reintervention rates. While these findings support early surgical intervention, larger, prospective studies are required to validate long-term outcomes and define patient selection criteria.