Endoscopic Modified Lothrop Procedure Research Articles

Endoscopic modified Lothrop procedure for postoperative frontal mucocele

Conclusion: The endoscopic modified Lothrop procedure was found to be useful for management of postoperative frontal mucocele. Objective: The aim of this study was to evaluate the efficacy of the endoscopic modified Lothrop procedure, in which bone resection in the lateral aspect of the frontal recess and frontonasal duct was avoided, for management of postoperative frontal mucocele. Patients and methods: The study prospectively assessed six patients who underwent an endoscopic modified Lothrop procedure. Patients had undergone a mean of two previous sinus surgical procedures. In our procedure, the mucosa and bone of the lateral aspect of the frontal recess and frontonasal duct were preserved, while a median drainage in the frontal sinus floor was created as large as possible. Results: All patients had a patent median drainage pathway and were free from preoperative symptoms with an average follow-up of 24.5 months. Although scar formation in the anterior aspects of the frontal recess was observed, no patients required revision surgery.

Rozwój koncepcji leczenia chirurgicznego zatok czołowych

The frontal sinus surgery has evolved over the past 120 years. There is an extensive literature focusing on this issue. The present review summarizes all major intranasal and external procedures in frontal sinus surgery. There were many techniques discovered and described in the literature; however, a single method that will lead to relief of clinical symptoms, complete eradication of disease with good functional outcome, minimal complications has not yet been attained. Frontoethmoidectomy alone has been the most frequently modified procedure by several authors. In mid-fifties of the last century the osteoplastic external surgery has emerged. Two decades later on new revolutionary endoscopic techniques have led to significant improvement in results of frontal sinus surgery. Endoscopic modified Lothrop procedure has become the most innovative method of frontal sinus surgery. Three dimensional computer assisted functional endoscopic sinus surgery and modern instrumentarium are among the latest techniques used nowadays, as they decrease the risk of complications and increase the precision and accuracy of surgical procedures.

前頭洞嚢胞３０症例の検討―術式と成績について―

Frontal sinus cyst is a relative common disease; however, this disease is often difficult to manage clinically since recurrence sometimes occurs even if patients are treated with surgery. We retrospectively analyzed 30 cases of the frontal sinus cyst, treated with surgery in our hospital between 1994 and 2006. The most common symptom was forehead swelling, followed by forehead pain, exophthalmos, and double vision; however, 3 (10%) cases did not have any clinical symptoms. Of 30 cases, 16 (53.3%) were postoperative cysts, and 14 (46.7%) were idiopathic cysts. Thirteen (43.3%) cases were treated by an external approach, and 12 (40.0%) cases were treated by an external approach combined with endonasal sinus surgery (ESS). Five (16.7%) cases were treated by ESS without external incision. The overall postoperative patency rate was 72.4%. The patency rate treated by the external approach, external approach combined with ESS, and ESS alone was 66.7%, 75.0%, and 80.0%, respectively. Although the number of patients treated by ESS alone was small, the clinical outcome of ESS was favorable. In several endonasal approaches, the endoscopic modified Lothrop procedure has been performed, and the postoperative clinical course is good. Thus, a modified Lothrop procedure might be a useful approach for frontal sinus cysts. The findings of the present study suggest that ESS would be the first choice of surgical approach for frontal sinus cysts.

Long-Term Effect of Stenting after an Endoscopic Modified Lothrop Procedure

The aim of this study was to study the effect of stenting with a silastic sheet on the long-term patency of the common frontal ostium after an endoscopic modified Lothrop procedure (EMLP). A retrospective analysis was performed of prospectively collected data at an academic tertiary referral center, where 72 patients underwent an EMLP between 1996 and 2003. Patency of the common frontal ostium was studied as an ordinal variable with three classes (patent, stenotic, and closed). A common ostium was endoscopically visualized in 94% of the patients (61.1% patent and 33.3% stenotic). Symptoms improved in 75% of the patients. A significant positive correlation was found between ostium patency and symptom improvement. Twenty-five patients were stented postoperatively. There was no statistical difference between the stented and the nonstented groups with regards to ostium patency and symptoms improvement. Short-term stenting does not appear to reduce the rate of postoperative stenosis of the common frontal ostium after an EMLP.

Anatomic Measurements for the Endoscopic Modified Lothrop Procedure

The aim of this study was to introduce preoperative radiographic frontal recess and sinus anatomic measurements to assist in the selection of patients considered for the modified Lothrop procedure. Data were collected from sagittally reconstructed computed tomography (CT) scans of seven cadaver heads. Four anatomic parameters for measurement were defined as follows: (1) thickness of the nasal beak (desirable < 10 mm); (2) midsagittal distance from nasal beak to skull base (adding 1 and 2 provides the anterior-posterior (AP) space at the cephalad margin of the frontal recess; desirable, > or = 15 mm); (3) accessible dimension (in a parasagittal plane through the frontal ostium; the distance between two lines drawn parallel to the plane of the anterior skull base and perpendicular to the line of the insertion of the nasal endoscope during surgery; the posterior line is drawn at the skull base and the anterior line is drawn at the posterior margin of the nasal beak; the distance between the lines indicates the space available for instrumentation; desirable, > 5 mm); (4) AP dimension of each frontal sinus. The average and the range of each parameter measured were as follows: (1) nasal beak thickness = 8.0 mm (5.0-10.4 mm); (2) nasal beak-skull base = 7.9 mm (2.5-14.1 mm); (3) accessible dimension, 6.1 mm (0.9-9.6 mm); (4) AP diameter of the frontal sinus, 9.7 mm (5.2-14.1 mm). Four specimens were considered candidates for modified Lothrop and three were not. Preoperative radiographic frontal recess and sinus anatomic measurements may assist in the selection of patients considered for the endoscopic modified Lothrop procedure.

Frontal ostium neo-osteogenesis and restenosis after modified endoscopic Lothrop procedure in an animal model.

All patients who undergo a modified endoscopic Lothrop procedure have postoperative narrowing of the enlarged frontal ostium. The aim of this study is to evaluate neo-osteogenesis and restenosis of the frontal ostium and its effect on mucociliary clearance. Fourteen sheep underwent an endoscopic modified Lothrop procedure. Pre- and postoperative nuclear medicine gamma scintigraphy of the frontal sinuses was performed. The sizes of the frontal ostia were measured and biopsies taken from the bone of the frontal ostium. Histological evidence of new bone formation was found in 56% of biopsies. The average preoperative mucociliary clearance half times (T1/2) at 15 and 30 min were 70 and 74 min, respectively, and postoperatively were 50 and 67 min. There was a non-significant trend towards poorer clearance in sinuses with neo-osteogenesis. The average size of the frontal ostium decreased by 28%. There was no relationship between the size of the ostium and neo-osteogenesis. Neo-osteogenesis was seen in 56% of biopsies with a 28% reduction in size of the frontal ostium after 224 days. Mucociliary clearance did not alter significantly.

The Effect of the Modified Endoscopic Lothrop Procedure on the Mucociliary Clearance of the Frontal Sinus in an Animal Model

The surgical management of recalcitrant frontal sinus disease has been a dilemma for otolaryngologists for many years. Although the osteoplastic flap with obliteration has been the gold standard of treatment for years, the modified endoscopic Lothrop (MEL) procedure recently has been advocated as an alternative. However, little is known about the effect of this procedure on the mucociliary drainage of the frontal sinuses postoperatively and this animal study addresses this issue. Fourteen sheep underwent the MEL procedure. The sheep were randomized regarding the use of postoperative irrigation via minitrephines. Each sheep had a nuclear medicine gamma-scintigraphy frontal sinus clearance study via minitrephines performed on each frontal sinus preoperatively and then 3 months postoperatively. Then, the results of these studies were compared. The scans revealed a trend toward faster clearance times postoperatively. However, this decrease was not statistically significant. Importantly, there was no trend or significant increase in clearance times postoperatively. Also, the use of postoperative irrigation was associated with a nonsignificant trend toward faster clearance times postoperatively. The MEL procedure has no adverse effects on the mucociliary clearance of the frontal sinus at 3 months postoperatively. Irrigation of the frontal sinus in the immediate postoperative period showed a trend toward improved postoperative mucociliary function at 3 months.

Endoscopic modified Lothrop procedure

Instrument advances and improvements in endoscopic techniques offer rhinologists more choices in the surgical management of patients requiring revision after failing primary sinus surgery, especially in the area of the frontal recess and frontal sinus. The endoscopic modified Lothrop procedure creates a common nasofrontal drainage pathway by resecting the superior nasal septum and removing the frontal sinus floors bilaterally to create a common drainage space. By avoiding external incisions and offering better postoperative surveillance, the modified Lothrop procedure offers distinct advantages over open techniques, but it requires advanced surgical expertise and specialized instrumentation.

The endoscopic modified Lothrop procedure for salvage of chronic frontal sinusitis after osteoplastic flap failure

Objective While reported results utilizing the osteoplastic flap procedure are very good, some patients fail the surgery due to recurrent or persistent frontal sinus disease. This study was performed to evaluate the utility of the endoscopic modified Lothrop sinus surgery for osteoplastic flap failure. Study design and setting A retrospective chart analysis and telephone survey of 10 patients from outside our institution for whom an osteoplastic flap with fat obliteration failed were salvaged using a computerized endoscopic modified Lothrop procedure. Results The main complaints were headache/pressure and recurrent infection. The usual pathology was chronic sinusitis and/or mucocele. The frontal recess and floor of the frontal sinus were the most common areas of persistent disease. Symptomatic clinical improvement was noted in more than 90% of patients. Conclusion Salvage endoscopic modified Lothrop sinus surgery is recommended for a limited number of traditional osteoplastic flap failures. Computerized surgical navigation may help avoid complications in situations with abnormal anatomy and previous dissection. Significance The endoscopic modified Lothrop procedure should be considered to salvage failed osteoplastic flap sinus obliteration.

Endoscopic modified Lothrop procedure for the treatment of chronic frontal sinusitis: a systematic review.

We sought to assess the safety and efficacy of the endoscopic modified Lothrop procedure (EMLP), performed either wholly intranasally or in combination with an external approach, against the osteoplastic flap (OPF) procedure with or without fat obliteration. All original, published studies on the EMLP and the OPF, with or without fat obliteration, were identified by searching Current Contents, Embase, MEDLINE, and The Cochrane Library. The search strategy for OPF was date-restricted to articles published after 1979 until February 2001. For both EMLP and OPF, only studies of patients diagnosed with chronic frontal sinusitis were included for review. English-language reports detailing randomized controlled trials, controlled clinical trials, case series, or case reports were included. The limited comparative data suggested that EMLP caused fewer adverse postoperative outcomes but was more likely to generate a perioperative cerebrospinal fluid leak than OPF. However, none of the morbidity traditionally associated with OPF was evident after EMLP. EMLP appeared to have a shorter operative time and a lower perioperative blood loss than OPF, but little could be determined regarding the long-term efficacy and durability of EMLP because of the relatively short follow-up of the majority of the studies. The evidence base for EMLP was deemed inadequate to assess its safety and efficacy, and an audit of the procedure was recommended. Additional clinical recommendations were made regarding the development and current practice of EMLP during this audit phase.

Surgical Techniques for the Removal of Frontal Recess Cells Obstructing the Frontal Ostium

Cells pneumatizing through the frontal ostium may vary in the degree of frontal sinus penetration. This series describes the use of the axillary flap technique and the endoscopic modified Lothrop procedure (EMLP) for the removal of cells that pneumatize to a varying degree through the frontal ostium into the frontal sinus. Out of a total of 204 patients undergoing endoscopic sinus surgery, 31 patients had a cell on one side and 7 patients had bilateral obstructive cells resulting in 38 sides undergoing an axillary flap approach for the removal of the obstructing cell. In 13 patients, the obstructing cell was deemed inaccessible by conventional technique and these patients underwent an EMLP for removal of the obstructing cell. All patients who underwent both the axillary flap approach and the EMLP had a patent frontal ostium confirmed endoscopically at the last follow-up visit. However, 8 of the 38 sides (21%) that underwent the axillary flap procedure had residual minor symptoms with four patients (30%) who underwent an EMLP having a recurrence of minor symptoms The axillary flap and the EMLP can be used to remove successfully ethmoidal cells that have pneumatized through the frontal ostium.