Draf III in the acute phase of pott's puffy tumor: a scoping review

Abstract

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. Summary Early surgical intervention is feasible: All included patients underwent Draf III surgery acutely (within 28 days), demonstrating the practicality of early intervention for Pott's puffy tumor. Excellent safety profile: Meta-analysis revealed a pooled complication rate of 0%, suggesting that acute Draf III surgery carries minimal perioperative risk. Low reintervention rate: The pooled reintervention rate of 3% supports the durability and efficacy of early Draf III in managing acute frontal sinusitis with osteomyelitis. Favorable outcomes with endoscopic approach: Most surgeries were performed endoscopically (88.9%), reflecting the advantages of minimally invasive techniques in reducing morbidity and recovery time. Need for further evidence: Although findings are consistent across available studies, larger prospective cohorts are required to confirm the long-term safety and efficacy of “Hot” Draf III procedures.