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.
To study the modified transnasal endoscopic Lothrop procedure (frontal drillout) in an appropriate animal model.Design: Pre-and postoperative three-dimensional (3D) CT scan, direct examination, and histologic study of the frontal sinuses of six cats undergoing frontal drillout.Setting: University animal facility.
Interventions:The cat has become a well-established animal model for frontal sinus surgery. In his early reports on anterior osteoplastic frontal sinus obliteration, William Montgomery described his early clinical results, as well as animal studies. He performed this operation in cats and killed them after 6 months, at which time he examined their sinuses and also obtained histologic and serial sections for examination and review. Donald and Fenton performed further studies using the cat model of the frontal sinus. In this study, six cats whose frontal sinuses had been assessed for size and patency by 3D CT scan underwent a modified Lothrop procedure. Three-dimensional CT was undertaken 6 months later, after which the animals were killed and the sinus cavities were opened and examined.Outcome measures: Quantitative evaluation of sinus patency measured on 3D CT scans and on direct visualization, and histologic examination of sinus mucosa.Results: All cats had widely patent sinuses, and histologic study revealed normal mucosa at 6 months. There were no complications.Conclusions: In the feline model, the modified Lothrop procedure resulted in a frontonasal communication that remained patent during the study period.
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