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Modified Lothrop procedure

Christopher R Roxbury, Dennis Tang, Janki Shah, Jennifer McBride, Troy D Woodard, Raj Sindwani
BACKGROUND: The endoscopic modified Lothrop procedure (EMLP) is commonly performed in recalcitrant frontal sinusitis, in part to achieve better penetration of medicated irrigations postoperatively. Although EMLP requires a septectomy for exposure, it is unknown whether septectomy size affects delivery of irrigations. In this study we evaluated the role of septectomy in delivery of irrigations to the EMLP cavity. METHODS: EMLP was performed on fresh human cadavers with sequentially increasing septectomy (minimal septectomy: drilling across septum to combine frontal sinuses; standard septectomy: 1...
June 8, 2018: International Forum of Allergy & Rhinology
Jasper Shen, Nadia Chan, Bozena B Wrobel
Background: Endoscopic Modified Lothrop Procedure (EMLP) has become a fundamental practice in rhinology. Improvements in symptom burden, ostial patency, morbidity, and costs have surpassed that of an open approach to the frontal sinus. Long-term efficacy has not been well established. Objective: This study details the long-term outcomes of EMLP and risk factors for subsequent surgical revision at a single institution. Methods: This study utilized a retrospective review of patients who underwent EMLP from September 2006 to February 2017 by a single surgeon at an academic tertiary referral center...
April 2018: Laryngoscope Investigative Otolaryngology
Toby O Steele, Oliver Y Chin, Michael R Kinzinger, E Bradley Strong
OBJECTIVE: Despite advances in technology and instrumentation, access to the lateral frontal sinus remains a challenge for surgeons. We sought to quantify the reach and applicability of the upper blepharoplasty approach (UBA) to the frontal sinus. METHODS: Twelve cadaveric specimens were obtained for anatomic research and frontal sinuses divided into 3 zones. Zone 1 was defined as medial to the supraorbital neurovascular bundle (SON). The remaining orbit was then bisected to define zone 2 (centrally) and zone 3 (laterally)...
March 2018: Annals of Otology, Rhinology, and Laryngology
Waleed M Abuzeid, Mayand Vakil, Juan Lin, Judd Fastenberg, Nadeem A Akbar, Marvin P Fried, Christina H Fang
BACKGROUND: The endoscopic modified Lothrop procedure (EMLP) has been used as a salvage technique for frontal sinusitis following failed endoscopic sinus surgery (ESS). We aim to examine the safety and efficacy of the EMLP following failure of primary ESS. METHODS: All English-language publications from 2000 to 2016 reporting the use of EMLP after primary ESS were identified using the PubMed database and evaluated per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines...
December 6, 2017: International Forum of Allergy & Rhinology
Liang-Chun Shih, Vishal S Patel, Garret W Choby, Tsuguhisa Nakayama, Peter H Hwang
OBJECTIVE: Since first described in the 1990s, the endoscopic modified Lothrop procedure (EMLP) has been the subject of a growing body of literature. We performed a review to compare indications and outcomes of EMLP in an early cohort of publications (1990-2008) versus a contemporary cohort (2009-2016) and compare outcomes associated with follow-up ≥2 years versus <2 years. DATA SOURCES: PubMed, SCOPUS and Cochrane databases. REVIEW METHODS: An English-language search of the PubMed and Ovid databases was conducted to identify publications from 1990 to 2016 reporting clinical outcomes of EMLP...
February 2018: Laryngoscope
Philip Locker, Max Plitt, Peter Papagiannopoulos, Ryan Smith, Bobby A Tajudeen
BACKGROUND: Iatrogenic injury to the trochlea is a potential complication of the Draf III or endoscopic modified Lothrop procedure; however, the location of the trochlea from within the sinus cavity has yet to be clearly characterized. We performed the first cadaveric study assessing the position of the trochlea in relation to the first olfactory neuron, a commonly identified landmark during the Draf III procedure. METHODS: Thirteen external dissections of the trochlea were performed on 7 disarticulated cadaveric heads via an extended Lynch type incision...
November 2017: International Forum of Allergy & Rhinology
Aria Jafari, Kathryn R Tringale, Bharat A Panuganti, Joseph R Acevedo, John Pang, Adam S DeConde
BACKGROUND: The endoscopic modified Lothrop (Draf-III) surgery has improved treatment of recalcitrant frontal sinus disease, with favorable safety and long-term results. However, the short-term clinical and quality-of-life morbidity after Draf-III relative to less-extensive procedures has yet to be investigated. OBJECTIVE: To evaluate the surgical and quality-of-life outcomes, including the burden of follow-up care, in patients who underwent endoscopic modified Lothrop (Draf-III), and compared these results with a less-extensive intervention, the endoscopic frontal sinusotomy (Draf-IIa)...
July 1, 2017: American Journal of Rhinology & Allergy
Eric T Carniol, Alejandro Vázquez, Tapan D Patel, James K Liu, Jean Anderson Eloy
BACKGROUND: Surgical management of the frontal sinus can be challenging. Extensive frontal sinus pneumatization may form a far lateral or supraorbital recess that can be difficult to reach by conventional endoscopic surgical techniques, requiring extended approaches such as the Draf III (or endoscopic modified Lothrop) procedure. Rigid endoscopes may not allow visualization of these lateral limits to ensure full evacuation of the disease process. METHODS: Here we describe the utility of intraoperative flexible endoscopy in two patients with far lateral frontal sinus disease...
June 1, 2017: Allergy & Rhinology
Jean Anderson Eloy, Emily Marchiano, Alejandro Vázquez
This review discusses extended endoscopic and open sinus surgery for refractory chronic rhinosinusitis. Extended maxillary sinus surgery including endoscopic maxillary mega-antrostomy, endoscopic modified medial maxillectomy, and inferior meatal antrostomy are described. Total/complete ethmoidectomy with mucosal stripping (nasalization) is discussed. Extended endoscopic sphenoid sinus procedures as well as their indications and potential risks are reviewed. Extended endoscopic frontal sinus procedures, such the modified Lothrop procedure, are described...
February 2017: Otolaryngologic Clinics of North America
D R Nayak, K Pai, S Nair, B Ramaswamy, H Sabhahit
To study the short-term functional outcomes of the endoscopic modified Lothrop procedure with well defined subjective and objective criteria. It's a retrospective cohort study with chart review carried out at a tertiary referral center. 31 patients with chronic frontal sinusitis who underwent endoscopic modified Lothrop's procedure with uncinate preservation during the period Jan 2011-2014 were followed up for a period of minimum 6 months. Assessment was done post-operatively based on subjective severity score and Kennedy's 5 point endoscopic criteria...
December 2016: Indian Journal of Otolaryngology and Head and Neck Surgery
Jessica E Southwood, Todd A Loehrl, David M Poetker
In the standard functional endoscopic sinus surgery (FESS) procedure, the amount of dissection is often determined by the extent of disease with the goal to preserve as much normal mucosa as possible while restoring ventilation and reestablishing mucociliary clearance. A subset of patients with chronic rhinosinusitis with nasal polyposis (CRSwNP), however, may continue to have persistent mucosal inflammatory and aggressive polyp regrowth despite standard FESS and maximal pharmacology therapy, leading to recurrent and recalcitrant disease...
2016: Advances in Oto-rhino-laryngology
N Choudhury, A Hariri, H Saleh
OBJECTIVE: The endoscopic modified Lothrop procedure is mainly used for refractory frontal sinusitis. However, we have used it as an access procedure to facilitate treatment for an extended range of additional frontal sinus pathologies. METHODS: A retrospective review of patients who underwent the endoscopic modified Lothrop procedure for 'alternative' frontal sinus pathologies was conducted. Patient data were reviewed. The main outcome parameter measured was signs of recurrence...
September 2016: Journal of Laryngology and Otology
Yad Ram Yadav, Vijay Parihar, Narayanan Janakiram, Sonjay Pande, Jitin Bajaj, Hemant Namdev
Cerebrospinal fluid (CSF) rhinorrhea occurs due to communication between the intracranial subarachnoid space and the sinonasal mucosa. It could be due to trauma, raised intracranial pressure (ICP), tumors, erosive diseases, and congenital skull defects. Some leaks could be spontaneous without any specific etiology. The potential leak sites include the cribriform plate, ethmoid, sphenoid, and frontal sinus. Glucose estimation, although non-specific, is the most popular and readily available method of diagnosis...
July 2016: Asian Journal of Neurosurgery
John R Craig, Dmitriy Petrov, Sammy Khalili, Steven G Brooks, John Y K Lee, Nithin D Adappa, James N Palmer
INTRODUCTION: Cerebrospinal fluid (CSF) leak occurs in 1-11% of endoscopic Draf III, or endoscopic modified Lothrop, procedures. CSF leak can occur during surgery during a superior nasal septectomy. This study investigated whether the posterior edge of the nasofrontal beak (NFB) at the level of the internal frontal ostium is a safe landmark to use to avoid skull base injury when beginning the superior septectomy. METHODS: Preoperative computed tomography maxillofacial scans were reviewed from 100 patients from the University of Pennsylvania sinus surgery data base...
May 2016: American Journal of Rhinology & Allergy
David K Morrissey, Ahmed Bassiouni, Alkis J Psaltis, Yuresh Naidoo, Peter-John Wormald
BACKGROUND: Patients with aspirin-exacerbated respiratory disease (AERD) and chronic rhinosinusitis with nasal polyps (CRSwNP) are often reported to be recalcitrant to standard medical and surgical intervention. Failure rates of standard endoscopic sinus surgery in these patients are reported to be as high as 90%. We review the outcomes for our cohort of AERD patients undergoing endoscopic sinus surgery and endoscopic modified Lothrop procedure (EMLP). METHODS: Data was collected prospectively between January 2001 and December 2013...
August 2016: International Forum of Allergy & Rhinology
David K Morrissey, Ahmed Bassiouni, Alkis J Psaltis, Yuresh Naidoo, Peter-John Wormald
BACKGROUND: Endoscopic modified Lothrop procedure (EMLP) is used to treat patients who fail conventional sinus surgery. The failure rate of a primary EMLP is reported to be between 5% and 32%. The failure rate of revision EMLP has not been reported. We present our institutions data regarding the outcome of patients requiring revision EMLP. METHODS: Data was collected prospectively. Patients undergoing primary EMLP between January 2001 and December 2013 with a minimum follow-up of 6 months were included...
May 2016: International Forum of Allergy & Rhinology
Justin H Turner, Reza Vaezeafshar, Peter H Hwang
BACKGROUND: Extended frontal surgery techniques are often required when maximal medical therapy and standard endoscopic surgical approaches fail in patients. Although outcomes of the Draf III (modified Lothrop) procedure have been widely reported, postoperative outcomes and indications for the Draf IIB frontal sinusotomy have been relatively underreported. We presented our institution's experience with the Draf IIB procedure. METHODS: Patients who underwent the Draf IIB frontal sinusotomy between 2007 and 2012 were identified by retrospective chart review...
January 2016: American Journal of Rhinology & Allergy
Apostolos Karligkiotis, Andrea Pistochini, Mario Turri-Zanoni, Paola Terranova, Luca Volpi, Paolo Battaglia, Maurizio Bignami, Paolo Castelnuovo
BACKGROUND: The management of frontal sinus disease still remains a challenging issue for rhinologists. Although endoscopic frontal sinus surgery has significantly advanced over the past years, there are some conditions in which the external approaches are still necessary. Recently, the increasing experience in endoscopic sinus surgery together with important technologic advancements have allowed expansion of the indications for selected lesions localized more and more lateral into the frontal sinus...
November 2015: American Journal of Rhinology & Allergy
Anna Knisely, Henry P Barham, Richard J Harvey, Raymond Sacks
BACKGROUND: The Draf 3 frontal sinusotomy, or modified Lothrop procedure has been used to treat recalcitrant rhinosinusitis, frontal sinus mucocoeles or to provide access for cerebrospinal fluid leaks, frontoethmoid fractures, frontal sinus tumors and skull base tumors. OBJECTIVE: To describe authors approach to the "Outside-In Frontal Drill-Out". METHODS: Descriptive. RESULTS: The "Outside-In" frontal drill-out is an approach that emphasizes the early identification of the first olfactory neuron, maximization of bone removal, and preservation of the posterior table mucosa...
September 2015: American Journal of Rhinology & Allergy
Tomasz Gotlib, Marta Held-Ziółkowska, Kazimierz Niemczyk
OBJECTIVES: Draf IIb approach provides wide, unilateral access to the frontal sinus. This approach can be extended without destruction of the contralateral frontal sinus drainage pathway, performed during Draf III (modified Lothrop) procedure. There is limited data in the literature regarding the use of modified Draf IIb procedures. METHODS: Patients treated with extended Draf IIb procedures in a single center were retrospectively assessed. RESULTS: Ten patients were identified, including 2 cases of osteoma, 1 inverted papilloma, 1 carcinoma, 5 mucoceles, and 1 chronic rhinosinusitis patient...
March 2015: Clinical and Experimental Otorhinolaryngology
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