Introduction: The DRAF III procedure is indicated for the treatment of benign and selected malignant frontal sinus pathology. Several attempts have been made to find an intra or pre-operative measurement that was predictive of the feasibility of this operation and its success. Among those, the frontal sinus outflow tract anteroposterior diameter (FOAP) appears to be the one with the highest applicability in clinical practice, since it is easy to measure on pre-operative CT scan. The objective of the study is to evaluate whether the minimum and maximum frontal sinus outflow anteroposterior diameters (FOAP min and FOAP max) are associated with the risk of failure and consequently with the need for surgical revision. Secondly, we ought to evaluate whether the angle between the glabella and the nasion on the sagittal plane could influence surgical outcome. Material and Methods: This is a retrospective study on patients who underwent DRAF III for benign pathologies at a tertiary Italian referral center from January 2000 to July 2022. FOAP min and FOAP max were measured on the mid-sagittal sections of a pre-operative CT scan. The glabella–nasion angle (G-N angle) was calculated on the same sagittal section. These measurements were compared between patients who experienced a recurrence and those who did not. If a post-operative CT scan was available, the obtained anteroposterior diameter (OD) of the frontal sinus neo-ostium was also measured on the same section. A correlation analysis was performed between the three pre-operative radiologic parameters and OD. Results: Twenty-nine patients were included in the study. Six patients experienced restenosis requiring surgical revision. The median FOAP max resulted significantly higher in patients who did not experience recurrence (median: 14.8 mm, IQR: 3.84) than in patients who experienced a recurrence (median: 11.9 mm, IQR: 1.14) (p = 0.04). The FOAP max also showed a good positive correlation with OD (p = 0.0001; r = 0.7). The correlation between FOAP min and OD was not statistically significant, nor was a correlation found between FOAP min and recurrence risk. The G-N angle was not significantly different in patients who experienced recurrence and those who did not, nor did it show a correlation with OD. Discussion: The FOAP max might be a valid pre-operative radiologic parameter to guide a surgeon’s approach to a DRAF III procedure, as it is easy to measure, shows a good correlation with OD, and seems to influence the risk of recurrence.

Objective: To report the long-term hearing outcomes after ossiculoplasty using the new semi-synthetic TORP. Study design: Prospective study. Setting: Tertiary referral center. Methods: From April to May 2023, 18 ossiculoplasties using the new semi-synthetic TORP were performed by the first author. In all patients, the new semi-synthetic TORP was placed between the stapes footplate and the tympanic membrane, both in the presence and absence of the stapes superstructure. The primary outcome was the long-term postoperative air-bone gap (ABG). Hearing stability over time was assessed by comparing short- and long-term postoperative ABG. Secondary outcomes included postoperative air-conduction pure-tone average (ACPTA), word recognition scores, and the percentage of patients achieving ABG ≤20 dB. The extrusion rate was also evaluated. Results: At short-term follow-up (mean: 8.5 mo), the ABG improved from a mean of 33.5 dB (SD=8.7) to 12.2 dB (SD=5.98); 88.8% of patients (16/18) achieved ABG ≤20 dB. The short-term postoperative ABG was significantly improved compared with preoperative values (t=27.7; P <0.05). At long-term follow-up (mean 24.5 mo), the ABG improved to 13.2 dB (SD=5.49), with 83.3% of patients (15/18) achieving ABG ≤20 dB (t=15.3; P 0.05). The extrusion rate was 0%. Conclusions: The new semi-synthetic TORP ossiculoplasty demonstrated excellent and stable long-term hearing outcomes with no extrusion.