Modified Hemi‐Lothrop Procedure for Supraorbital Frontal Sinus Access

Abstract

The MHLP was demonstrated to be a feasible approach and alternative to more traditional endoscopic procedures in addressing unilateral frontal sinus disease. This modification may be useful in addressing difficult to access unilateral disease that may otherwise require more extensive resection. This demonstration helps define the accessibility of the lateral frontal sinus via an MHLP and begins to provide estimates of which patients may benefit from this approach.

Endoscopic Marsupialisation of the Lateral Frontal Sinus Mucocele With Orbital Extension: A Case Report

“…For sinuses pneumatized laterally beyond the midorbital point, only 10% of lateral orbital roofs were accessible (10). In another study performed on three cadavers for unilateral frontal lesions, the Modified hemi-Lothrop Procedure was shown to provide adequate access to lateral frontal and distal supraorbital sinus diseases from the contralateral nasal cavity via a superior septectomy window (11). In our case, frontal mucocele was situated laterally, but by removing lamina papyracea, endoscopic operation was performed successfully.…”

Preventing and Managing Complications in Frontal Sinus Surgery

“…9,25-27 Similar precautions should be undertaken as in any other frontal sinus procedure, including awareness of the location of the skull base and the orbit. Variations in the Draf procedures have been described by Eloy and colleagues, [28][29][30][31][32][33][34] and require the same type of precautions to prevent complications. Frontal sinus surgery series with appreciable numbers of patients are sparse, meaning the true complication rates are not known and likely vary based on characteristics relating to patient selection and surgeon experience.…”

Endoscopic Approaches to the Frontal Sinus

“…2). [5][6][7] The procedure combines an ipsilateral Draf IIB (removal of the frontal sinus floor from the nasal septum medially to the lamina papyracea laterally) and a superior septectomy. The superior septectomy window allows insertion of an endoscope and instruments via the contralateral side, thus providing greater access and visualization of the lateral frontal sinus recess of the affected ipsilateral frontal sinus or supraorbital ethmoid.…”