Close in 1994, and Gross in 1995 described the endoscopic modified Lothrop. All patients selected for this procedure had failed medical treatment of nasal saline and antiseptic irrigations, topical steroids, and appropriate antibiotics. Nearly all of these patients had also failed standard endoscopic sinus procedures at least once.Results: Image guidance has improved the precision and safety of this operation. Three of the first 5 procedures performed without image guidance failed. Of the succeeding 99 procedures performed with image guidance, 96% were successful in maintaining open frontal drainage and resolving most symptoms with a prolonged follow-up (mean 42 months).Conclusions: The endoscopic modified Lothrop is a technically difficult procedure. When performed under the supervision of an experienced endoscopic surgeon with image guidance and modern endoscopic irrigated curved drills, it can be performed safely and effectively when standard endoscopic procedures fail. Endoscopic Resection of Anterolateral Maxillary Sinus Inverted PapillomasNichole Dean, DO (presenter); Elisa A. Illing, MD; Bradford A. Woodworth, MD Objectives: Endoscopic medial maxillectomy (EMM) has become the surgical procedure of choice for resection of maxillary sinus inverted papillomas (IPs). Traditionally, IPs pedicled on the anterior and/or lateral walls of the maxillary sinus have required an adjuvant Caldwell-Luc approach due to decreased visualization with transnasal endoscopy in these locations. The objective of the current study is to evaluate outcomes concerning the endoscopic surgical resection of anterolateral maxillary sinus IPs.Methods: A prospective review of patients presenting with maxillary sinus IPs pedicled on the anterior and/or lateral walls was performed. Demographics, pedicle location, operative technique, pathology, complications, recurrence, and postoperative follow-up were evaluated.Results: Over 6 years, 35 patients (avg. age 56) underwent EMM for maxillary sinus IPs located on the anterolateral maxilla. Most patients (69%) were referred for recurrence after previous attempts at surgical resection. Adequate visualization was obtained following EMM in the majority of patients with use of a 70° endoscope and angled instrumentation. The addition of transseptal surgical access was critical to the removal of IPs in 16 patients. No Caldwell-Luc approaches were required. Pathologic dysplasia was identified in 8 subjects, and 3 had carcinoma. There were no recurrences with a mean disease-free interval of 27 months (6-72 months).Conclusions: In the present study EMM provided excellent surgical access to anterolateral maxillary sinus IPs. The transseptal approach allowed enhanced visualization to this challenging location previously considered accessible only with external procedures.

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Objectives/Hypothesis The objective of this study was to report for the first time on the results of submucosal injections of bevacizumab used in conjunction with cyanoacrylate glue sclerotherapy in hereditary hemorrhagic telangiectasia (HHT). Study Design Retrospective analytic chart review. Methods We performed a chart review that included all patients with HHT treated with intranasal bevacizumab and cyanoacrylate glue for refractory epistaxis at Lariboisiere University Hospital from 2013 with a minimum follow‐up of 6 months. We injected 100 mg (25 mg/mL) of bevacizumab diluted in 2 mL of serum at the base of the telangiectasias, and sclerotherapy with an injection of cyanoacrylate glue was used adjunctively. Treatment efficacy was based on changes in Epistaxis Severity Scores (ESS) and the Bergler‐Sadick Scale. Quality of life and patient satisfaction were evaluated using the Cantril Self‐Anchoring Ladder (CL) and Likert scale, respectively. Results Thirty‐one patients were included, with a mean follow‐up of 26.6 months. The average ESS score significantly decreased from 7.82 to 3.89 (P < .05). The Bergler‐Sadick score significantly improved (P < .05) following the treatment, including the frequency (from 2.74 to 1.64) and the quantity (from 2.54 to 1.51) scales. Quality of life was significantly improved (P < .05) using the CL score (from 4.16 to 7.22). The Likert satisfaction scale related to the treatment efficacy was high, with an average of 7.03 out of 10. No complications were noted. Conclusions Submucosal injections of bevacizumab in conjunction with cyanoacrylate glue sclerotherapy significantly reduced epistaxis and improved the quality of life in HHT. Prospective comparative studies are needed to further evaluate the significance of this treatment modality. Level of Evidence 3b Laryngoscope, 129:2210–2215, 2019

Human papillomavirus rate was lower than reported rates in Western populations. Possible explanations include differences in social and cultural behaviours.

Objectives To systematically review the literature to evaluate the indications, safety, and efficacy of the Draf IIb procedure and to evaluate the added advantages of technical factors such as stents and flaps. Data Sources Articles published until July 2019 on Medline and Cochrane databases. Review Methods After a systematic review based on the 2018 PRISMA guidelines was conducted, 26 of 1533 articles were included and reviewed for indications of Draf IIb; surgical technique; use of flaps, stents, grafts, or mitomycin; complications during and after surgery; and success or recurrence rate. Results The main indication for Draf IIb was chronic frontal rhinosinusitis (61.82%). The postoperative patency rate was 87.85%. When flaps/grafts were applied, the rate was 93.5%, but their added value was not statistically significant. Stents could be an alternative for revision surgery. Treating frontal pathologies other than chronic rhinosinusitis was also satisfying. Safety was comparable to Draf III: no perioperative complications were reported, only a few postoperative ones (eyelid ecchymosis and periorbital cellulitis in 0.2% of the cases, hyposmia in 1.55%). Conclusion When properly indicated, Draf IIb frontal drilling is a safe and highly effective surgical technique for frontal pathology treatment, with efficiency and safety comparable to the Draf III, making it a valid option when a bilateral approach is not needed. More studies are required to confirm the added values of flaps, grafts, and stents.