Modified transnasal endoscopic Lothrop procedure as an alternative to frontal sinus obliteration

Abstract

Persistent frontal sinusitis traditionally has been treated with external procedures such as osteoplastic frontal sinus obliteration or the Lynch procedure. Currently, functional endoscopic sinus surgery can be used in most cases to remove disease from the frontal recess, the most frequent site of frontal sinus obstruction, thereby relieving the sinusitis. In some cases, however, frontal recess exploration has failed to relieve the obstruction of the frontal sinus, necessitating an osteoplastic frontal sinus obliteration. We present our experience with a transnasal modification of the Lothrop procedure. The Lothrop procedure, first described in 1914, uses a combined external and transnasal approach to resect the median frontal sinus floor, superior nasal septum, and intersinus septum to drain the frontal sinus. This procedure was largely abandoned and forgotten by modern otolaryngologists. However, with the advent of the computed tomography scan and endoscopic techniques, we sought to reassess the basic tenant of the Lothrop procedure (i.e., wide median frontal sinus drainage). An anatomic study of cadaver heads was performed to quantify the surprisingly large potential opening and to better understand the pertinent anatomy. This procedure was performed on 10 patients, with no resulting complications and no failure to maintain patency of the frontal sinus drainage throughout the follow-up period (mean, 7 months). We are encouraged by our initial favorable results and intend to use the procedure in the future as needs arise.

Clinical Outcome of Endoscopic Surgery for Frontal Sinusitis

“…8 The remainder underwent bilateral drillouts using a transseptal technique, similar to the Draf 3 procedure and modified Lothrop procedures. 8,10 All surgeries were performed with patients receiving general anesthesia.…”

“…Close et al 9 and Gross et al 10 described a similar technique for treatment of patients with advanced disease, using endoscopic instrumentation to create a large aperture between the frontal sinuses and nasal cavity. This frontal sinus drillout procedure has been compared with that of Lothrop,11 who in 1914 described a combined external and intranasal approach to resect the frontal sinus floor and septum.…”

Clinical Features of Patients Treated with Endoscopic Sinus Surgery for Posttraumatic Paranasal Sinus Mucocele

“…To avoid recurrent obstruction of the frontal sinus drainage route, the mucoceles must be widely opened. For the endoscopic approach, Draf IIb and III drainage procedures were required to enlarge the outflow tract from the frontal sinus [20,21,22]. The opened drainage route appeared to be narrow in case 4 (fig.…”

Obliteración del seno frontal para el tratamiento de fístulas de LCR y meningoencefaloceles

“…Descrita en 1914, la técnica original consistía en combinar un abordaje externo y uno transnasal para realizar una resección del suelo medial del seno frontal, del tabique nasal en su porción superior y del septo intersinusal con el fin de conseguir un buen drenaje del seno frontal 13,18 . A finales de la década de los '90 se publicaron varios trabajos que describían una variante de esta técnica realizada por endoscopía, especialmente para el tratamiento de sinusitis cróni-cas, consiguiendo un amplio drenaje del seno frontal, con buenos resultados, comparables a la técnica de la obliteración con grasa 19,20 .…”