{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T11:33:14Z","timestamp":1774870394816,"version":"3.50.1"},"reference-count":21,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2018,9,19]],"date-time":"2018-09-19T00:00:00Z","timestamp":1537315200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>The Draf III frontal sinusotomy is an established surgical procedure with an important role in the surgical management of recalcitrant chronic rhinosinusitis (CRS). In 2012, the outside\u2010in approach to the Draf III was described as a safe and efficient procedure. Smell recovery in inflammatory CRS is challenging, and to date there is limited evidence suggesting that Draf III improves patient\u2010reported olfactory dysfunction from CRS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A consecutive series of patients who underwent an outside\u2010in Draf III for inflammatory CRS by a single, tertiary rhinologist were reviewed. Patients were excluded if the Draf III was performed for noninflammatory conditions. Postoperatively, patients were maintained on long\u2010term corticosteroid irrigations, and adherence was assessed. Prospectively collected data included patient demographics, a visual analogue scale for smell, overall Sinonasal Outcome Test Score (SNOT\u201022), global nasal function score, and a clinician\u2010graded clinical outcome score.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>One hundred and four patients (41.1% female) aged 54\u2009\u00b1\u200912 years underwent an outside\u2010in Draf III. The median follow\u2010up time was 30.6 months (range 12.2\u201372.1). The majority of patients rated their smell loss as moderate or worse preoperatively; however, this was significantly improved at postoperative review (71.2% vs. 27.6%; Kendall tau\u2010b, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.01). The SNOT\u201022 score improved after surgery (2.32\u2009\u00b1\u20091.09 vs. 0.78\u2009\u00b1\u20090.69, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.0001). Medication adherence was significantly associated with improved clinical outcome score (Kendall tau\u2010b, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.004). Aspirin exacerbated respiratory disease was found to be a significant risk factor predicting poor clinical outcome on univariate analysis (Odds Ratio\u2009=\u20094.69 (1.03\u201321.2), <jats:italic>P<\/jats:italic>\u2009=\u20090.04).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The outside\u2010in Draf III appears to facilitate sustained, meaningful improvement in several self\u2010reported outcomes, including smell. However, further study and comparison to less aggressive surgery will be required to confirm its true benefit.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>Level 4 <jats:italic>Laryngoscope<\/jats:italic>, 129:25\u201330, 2019<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.27352","type":"journal-article","created":{"date-parts":[[2018,9,19]],"date-time":"2018-09-19T12:05:08Z","timestamp":1537358708000},"page":"25-30","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Patient\u2010reported olfaction improves following outside\u2010in Draf III frontal sinus surgery for chronic rhinosinusitis"],"prefix":"10.1002","volume":"129","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5799-5083","authenticated-orcid":false,"given":"Eugene H.","family":"Wong","sequence":"first","affiliation":[{"name":"Rhinology and Skull Base Research Group, Applied Medical Research Centre University of New South Wales Sydney Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy Q.","family":"Do","sequence":"additional","affiliation":[{"name":"Rhinology and Skull Base Research Group, Applied Medical Research Centre University of New South Wales Sydney Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard J.","family":"Harvey","sequence":"additional","affiliation":[{"name":"Rhinology and Skull Base Research Group, Applied Medical Research Centre University of New South Wales Sydney Australia"},{"name":"Faculty of Medicine and Health Sciences Macquarie University Sydney Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carolyn A.","family":"Orgain","sequence":"additional","affiliation":[{"name":"Rhinology and Skull Base Research Group, Applied Medical Research Centre University of New South Wales Sydney 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