The transnasal endoscopic route offers excellent visualization of the posterior choana and, hence, the ability to open the defect widely with a high surgical success rate. Newer powered instrumentation further enhances the ability to perform this technique cleanly.

Current surgical treatment of the frontal sinus disease include external approaches to obliterate or ablate the sinus and both external and transnasal methods to restore drainage into the nasal cavity. The original Lothrop procedure resects the medial frontal sinus floor, superior nasal septum, and intersinus septum, creating a large frontonasal communication. However, as described, the external approach used in this procedure often allowed medial collapse of soft tissue and the stenosis of the nasofrontal communication. This report further relates our experience with the modified transnasal endoscopic Lothrop procedure using suction drills for cases in which frontal recess exploration had failed to relieve obstruction of the frontal sinus. We present an update of the University of Virginia experience in performing the modified Lothrop procedure in 20 patients from 10/93 to 4/95. Our findings over the follow-up period (average 12 months) have verified that this procedure is effective, with a 95% patency rate for the surgically enlarged frontal sinus ostium. When compared to osteoplastic flap with fat obliteration, the modified transnasal Lothrop procedure offers the advantages of a less invasive procedure with a shorter and usually no hospitalization, less morbidity, and the increased ability to evaluate post-operatively for recurrent disease. A patient charge analysis was also performed comparing patients undergoing frontal sinus obliteration during the same time period, revealing an additional benefit of decreased patient costs for the modified transnasal Lothrop procedure. None of our patients experienced complications, and all showed significant improvement, if not complete resolution of their symptoms. Although this procedure has produced favorable results, it should be noted that this procedure is technically demanding and will require further long term follow-up to verify its efficacy and proper role in the spectrum of surgical approaches for the treatment of chronic sinusitis.

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Antimicrobial therapy is a part of the care of patients with chronic sinus disease (CSD), but the etiologic role of microorganisms in this condition is unclear. Twenty patients with CSD undergoing functional endoscopic sinus surgery who had been off antibiotics for at least 1 week before surgery had a maxillary sinus aspirate for quantitative culture for aerobic bacteria and fungi and a semiquantitative culture from the antrostomy of the same maxillary sinus during endoscopic surgery. Six (30%) of the patients had infection of the maxillary sinus diagnosed by the presence of ≥ 103 cfu/mL of organisms in the sinus aspirate (Haemophilus influenzae in two patients and one patient each with Moraxella catarrhalis, α-streptococcus, mixed oropharyngeal flora, or Alternaria sp.). All antrostomy specimens obtained by nasal endoscopy during surgery were positive, but the antrostomy cultures did not correlate with the sinus aspirate cultures from the same sinus. Staphylococcus aureus and/or Gram negative rods in eight antrostomy cultures did not predict the presence of these pathogens in any of the maxillary sinus aspirates. Conversely, the bacteria detected with the quantitative aspirate culture in five of the six infected sinuses were not found in the antrostomy specimen; only the fungal sinus infection correlated with the antrostomy culture. Infection of the maxillary sinuses occurred in patients with both limited and severe disease by CT imaging. About one third of patients with CSD necessitating surgery had microbial infection of the maxillary sinus, but antrostomy cultures obtained via endoscopy did not predict the organisms infecting the sinus.

Plain films of the paranasal sinus were the imaging technique most frequently used before the advent of computed tomography. With improved resolution, computed tomography imaging has become the standard for evaluating patients with disease of the paranasal sinuses. With the widespread availability of computed tomography scanning, patients are likely to undergo multiple examinations during the treatment of their disease. Concern has been raised over the radiation exposure to the patient, in particular, with regard to radiation-induced cataracts. The purpose of this study is to measure the radiation dose associated with a variety of techniques for imaging the paranasal sinuses. A cadaveric specimen with thermoluminescent dosimeters placed over the orbits was used to measure radiation exposure during plain-film imaging, limited computed tomography, standard axial and coronal computed tomography, thin-cut axial computed tomography, and thin-cut coronal computed tomography. The measured dose in all these techniques is less than 4% of the acute dose associated with cataract formation.

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Plain films of the paranasal sinus were the imaging technique most frequently used before the advent of computed tomography. With improved resolution, computed tomography imaging has become the standard for evaluating patients with disease of the paranasal sinuses. With the widespread availability of computed tomography scanning, patients are likely to undergo multiple examinations during the treatment of their disease. Concern has been raised over the radiation exposure to the patient, in particular, with regard to radiation-induced cataracts. The purpose of this study is to measure the radiation dose associated with a variety of techniques for imaging the paranasal sinuses. A cadaveric specimen with thermoluminescent dosimeters placed over the orbits was used to measure radiation exposure during plain-film imaging, limited computed tomography, standard axial and coronal computed tomography, thin-cut axial computed tomography, and thin-cut coronal computed tomography. The measured dose in all these techniques is less than 4% of the acute dose associated with cataract formation.