Evolution of the endoscopic modified Lothrop procedure: A systematic review and meta‐analysis

Shih, Liang‐Chun; Patel, V. C.; Choby, Garret; Hwang, Peter H.

doi:10.1002/lary.26794

Cited by 29 publications

(31 citation statements)

References 47 publications

(96 reference statements)

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“…Our total revision rate in the whole cohort was 4% (2 of 50), for a mean follow‐up period of 2.9 years, which is comparable with findings from earlier studies . Of note, the revision rate was higher in the control group (8.7%, 2 of 23) than in the mucosal grafts and flaps group (0%, 0 of 27).…”

Section: Discussionsupporting

confidence: 88%

Free mucosal grafts and anterior pedicled flaps to prevent ostium restenosis after endoscopic modified Lothrop (frontal drillout) procedure: a randomized, controlled study

Wang

Shen

Hsieh

et al. 2019

Int Forum Allergy Rhinol

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Background:The endoscopic modified Lothrop procedure (EMLP) is used to manage ongoing refractory frontal sinusitis a er failed previous endoscopic sinus surgery (ESS), but this approach has a significant restenosis rate. We evaluated the potential benefits of mucosal gra s and pedicled flaps on the opening of the newly formed frontal ostium. Methods:Fi y patients with refractory frontal sinusitis or mucoceles a er ESS were randomized to undergo EMLP, either with (n = 27) or without (n = 23) mucosal gra s and pedicled flap reconstruction of the neo-ostium. The frontal neo-ostium was measured with Lindholm distending forceps, and anteroposterior (A-P) and lateral dimensions were measured intraoperatively, and then again at 6 weeks, 6 months, and 12 months postoperatively. Olfaction outcomes were assessed using the Taiwan Smell Identification Test (TWSIT) and a smell visual analog scale (VAS) score preoperatively and at 6 months postsurgery. Results:The initial intraoperative mean lateral and A-P dimensions were 23.2 ± 2.7 mm and 14.8 ± 2.3 mm and were significantly decreased at all time-points postoperatively. The mucosal gra s and pedicled flaps had greater lateral and A-P dimensions, and a greater percentage of intraoperative frontal neo-ostium area at all time-points postoperatively (all p < 0.05). At 6 months postoperatively, TWSIT (p = 0.027), but not the smell VAS score (p = 0.063), was significantly improved compared with baseline. TWSIT and smell VAS score changes did not differ between groups (p = 0.92 and p = 0.85, respectively). Conclusion:The use of mucosal gra s and pedicled flaps reduces stenosis of the frontal neo-ostium postsurgery and should be considered a er EMLP. C 2019 ARS-AAOA, LLC.

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Section: Discussionsupporting

confidence: 88%

Free mucosal grafts and anterior pedicled flaps to prevent ostium restenosis after endoscopic modified Lothrop (frontal drillout) procedure: a randomized, controlled study

Wang

Shen

Hsieh

et al. 2019

Int Forum Allergy Rhinol

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“…In our Draf 3 cohort, 86.7% of patients at last follow‐up showed improved SNOT‐22 scores greater than the MCID, while a recently published systematic review on Draf 3 outcomes reported significant symptom improvement in 86.5% of patients. In our series, 88.2% had patent neo‐ostia and 11.8% required revision surgery; similarly, the same systematic review showed patent neo‐ostia in 90.7% of patients and a 12.6% revision rate . While no systematic review of the Draf 2B procedure exists to our knowledge, the results of our Draf 2B cohort appear similar to previously published case series …”

Section: Discussionsupporting

confidence: 89%

“…It is important to acknowledge that we excluded patients with more severe comorbidities, for which the Draf 3 procedure has been more commonly utilized than the Draf 2B . Because the Draf 3 procedure results in a wider, interconnected frontal cavity with enhanced medial and lateral frontal sinus access, there may be surgical indications for which the Draf 3 may be preferable, such as ciliary dyskinesia or tumors.…”

Section: Discussionmentioning

confidence: 99%

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Equivalence in outcomes between Draf 2B vs Draf 3 frontal sinusotomy for refractory chronic frontal rhinosinusitis

Patel

Choby

Shih

et al. 2017

Int Forum Allergy Rhinol

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Background Endoscopic Draf 2B and Draf 3 frontal sinusotomies are frequently performed for chronic refractory frontal rhinosinusitis. The purpose of this study was to compare outcomes between Draf 2B and Draf 3 procedures. Methods A retrospective cohort study was conducted comparing patients undergoing bilateral Draf 2B vs Draf 3 procedures from 2000 to 2016. Patients with neoplasia, dysplasia, mucocele, cystic fibrosis, or ciliary dyskinesia were excluded. Preoperative disease parameters included number of prior surgeries, presence of polyps, preoperative 22‐item Sino‐Nasal Outcome Test (SNOT‐22) score, frontal Lund‐Mackay score, anterior‐posterior diameter of the frontal ostium, and Global Osteitis Scoring Scale (GOSS). Postoperative outcomes included SNOT‐22 score, neo‐ostium patency, surgical revision rates, and complications. Results A total of 21 patients with bilateral Draf 2B and 17 patients with Draf 3 surgeries were compared. Mean follow‐up time was 15.6 months. No significant differences were seen between groups for any preoperative disease parameter. Both cohorts showed statistically significant (p = 0.0001 [Draf 2B]; p = 0.0001 [Draf 3]) and clinically meaningful (Δ = 24.1; Δ = 24.9) improvements in SNOT‐22 at last follow‐up vs preoperatively. The Draf 2B group had greater improvement in SNOT‐22 score than the Draf 3 group at 1 to 3 months (p = 0.003), but the magnitude of improvement equalized at 5 to 9 months (p = 0.66) and last follow‐up (p = 0.90). No significant differences were noted between groups regarding patency, revision rates, or complications. Conclusion Both Draf 2B and Draf 3 procedures offer durable symptomatic improvement for patients with refractory frontal CRS. The Draf 2B is associated with earlier postoperative symptom improvement and overall shows comparable long‐term outcomes to the Draf 3 sinusotomy.

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“…Con el desarrollo de la cirugía endoscópica nasal, las aplicaciones del Draf III se han ampliado. Actualmente incluyen la resección de diversos tipos de tumores del seno frontal, cierre de fístulas de líquido cefalorraquídeo, manejo de fracturas del seno frontal y como parte de abordajes endonasales extendidos a la fosa craneal anterior, entre otras 3 .…”

Section: Introductionunclassified

Abordaje endoscópico del seno frontal mediante Draf III. Experiencia de la Red de Salud UC Christus

et al. 2019

Rev. Otorrinolaringol. Cir. Cabeza Cuello

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Evolution of the endoscopic modified Lothrop procedure: A systematic review and meta‐analysis

Abstract: In the last decade, EMLP has been performed more frequently for tumors. Recent studies have demonstrated improved symptom outcomes and a trend toward improved patency rates. The revision rate increased significantly when follow-up exceeded 2 years. Laryngoscope, 128:317-326, 2018.

Cited by 29 publications

References 47 publications

Free mucosal grafts and anterior pedicled flaps to prevent ostium restenosis after endoscopic modified Lothrop (frontal drillout) procedure: a randomized, controlled study

Free mucosal grafts and anterior pedicled flaps to prevent ostium restenosis after endoscopic modified Lothrop (frontal drillout) procedure: a randomized, controlled study

Equivalence in outcomes between Draf 2B vs Draf 3 frontal sinusotomy for refractory chronic frontal rhinosinusitis

Abordaje endoscópico del seno frontal mediante Draf III. Experiencia de la Red de Salud UC Christus

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