Follow-Up of University of Virginia Experience with the Modified Lothrop Procedure

Abstract

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.

An Evidence-Based Review of Endoscopic Frontal Sinus Surgery

“…6,10-12 These studies are case series with multiple independent arms or independent cohorts compared over time. In a study by Gross et al, 10 Copyright (c) Oceanside Publications, Inc. All rights reserved. For permission to copy go to https://www.oceansidepubl.com/permission.htm time periods.…”

The frontal osteoplastic flap: does it still have a place in rhinological surgery?

“…Gross et al reported the cost advantage of the endoscopic modified Lothrop procedure over the frontal osteoplastic flap procedure with obliteration. 11 However, unlike the frontal osteoplastic flap procedure with obliteration, patients who undergo an endoscopic modified Lothrop procedure require frequent postoperative clinic visits to ensure patency of the frontal sinus opening, with toileting of the frontal sinus cavity to remove clots, crust, polyps and/or granulation. The additional cost of these clinic visits was not included in Gross and colleagues' cost analysis.…”

“…Other complications reported for the endoscopic modified Lothrop procedure include transient blurring of vision, which in one study resolved spontaneously by post-operative day one 11. …”

Outcomes After Frontal Sinus Surgery

“…The literature on Draf III frontal sinusotomies is similar to that on the Draf IIa consisting predominantly of case series from single institutions (Table 3) 24,26,39,41– 61 with similar outcomes. In some ways, though, more evidence has been published on this salvage surgery that is required in only a minority of patients with CRS.…”

“… LOE = level of evidence, RCS = retrospective case series, OPF = osteoplastic flap, * endpoint reported is endoscopic closure, not revision surgery Data from Refs 24,39,26,41–61. …”