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Modified Lothrop procedure

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
Cheng Li, Qian Huang, Shunjiu Cui, Ting Ye, Zhenxiao Huang, Fei He, Bing Zhou
OBJECTIVE: To evaluate the impact of nasal function after Draf III frontal sinus surgery (Draf III) or the modified endoscopic Lothrop procedure (EMLP). METHODS: It was a prospective study with self-control. The pre-operative clinical data of 30 patients (from 2010 to 2013, Beijing Tongren Hospital) who underwent Draf III surgery, with the testing results of T&T olfactory testing, acoustic rhinometry and rhinomanometry before and 1 year after operation in these patients were collected in this study...
September 2014: Zhonghua Er Bi Yan Hou Tou Jing Wai Ke za Zhi, Chinese Journal of Otorhinolaryngology Head and Neck Surgery
James K Liu, Zachary S Mendelson, Pariket M Dubal, Neena Mirani, Jean Anderson Eloy
Tumors in the supraorbital region are most commonly accessed through transcranial approaches, including fronto-orbital, orbitozygomatic, and eyebrow supraorbital keyhole approaches. Purely endoscopic endonasal approaches (EEA) are more challenging to perform because of limitations in access and visualization for lateral extension beyond the midline corridor. The modified hemi-Lothrop procedure, a variation of an extended EEA, allows for binostril access and visualization of the lateral supraorbital region while preserving the contralateral frontal sinus drainage pathway...
December 2014: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Mohamed R ElBadawey, Ahmad Alwaa, Mostafa ElTaher, Sean Carrie
BACKGROUND: There is a lack of reports on the quality of life (QOL) assessment after frontal sinus surgery. This study aimed to assess the QOL of patients after one of three frontal sinus procedures, using the Glasgow Benefit Inventory (GBI) and the 22-item Sino-Nasal Outcome Test (SNOT-22). METHODS: We designed an observational study with two arms. The first arm was a cross-sectional retrospective study recruiting all patients (with rhinosinusitis or mucocele) who had balloon sinuplasty, frontal recess clearance, or endoscopic modified Lothrop procedure in our tertiary referral unit at Newcastle upon Tyne Hospitals, between April 2010 and April 2012...
September 2014: American Journal of Rhinology & Allergy
Abdulaziz AlQahtani, Maurizio Bignami, Paola Terranova, Elena Digilio, Francesca Basilico, Shawkat Abdulrahman, Paolo Castelnuovo
Despite advances in endoscopic approaches, instrumentations and imaging guidance systems, the management of frontal sinus is still challenging. Failure of the endoscopic procedure and restenosis of the newly formed ostium have been demonstrated even with large frontal sinusotomy. We describe a newly designed double nasoseptal flap to cover the bare bone after endoscopic modified Lothrop procedure (EMLP). Five fresh, double-injected cadavers were dissected through an endoscopic endonasal approach. Posteriorly based nasoseptal flap on one side and laterally based nasoseptal flap on the other side were harvested before performing wide EMLP...
November 2014: European Archives of Oto-rhino-laryngology
Jean Anderson Eloy, Leila J Mady, Vivek V Kanumuri, Peter F Svider, James K Liu
BACKGROUND: The endoscopic modified Lothrop procedure (EMLP) is well established for resistant frontal sinus disease and anterior skull base (ASB) exposure. However, this technique may be unnecessarily aggressive by removing avoidable sinonasal structures in select cases. Previously, in a cadaveric study, we proposed a modification of the EMLP, termed the modified subtotal-Lothrop procedure (MSLP), to access the ASB and to address complex frontal sinus disease, for which access to the bilateral frontal sinus posterior table is required...
June 2014: International Forum of Allergy & Rhinology
Jean Anderson Eloy, James K Liu, Osamah J Choudhry, Amy S Anstead, Belachew Tessema, Adam J Folbe, Roy R Casiano
Objective The endoscopic modified Lothrop procedure (EMLP) is an established approach for recalcitrant frontal sinus disease and anterior skull base exposure. However, in select cases, this technique may involve unnecessary resection of sinonasal structures. In this study, we propose a modification of the EMLP, termed the modified subtotal-Lothrop procedure (MSLP), to access the anterior skull base and complex frontal sinus disease for which access to the bilateral frontal sinus posterior table is required...
June 2013: Journal of Neurological Surgery. Part B, Skull Base
Kazuhiro Nomura, Yohei Honkura, Yuri Okumura, Atsuko Kasajima, Takahiro Suzuki, Toshiaki Kikuchi, Hiroshi Hidaka, Takeshi Oshima, Yukio Katori
Isolated frontal sinusitis with mixed bacterial colonies is extremely rare and has not been described. We report a case of isolated frontal sinus forming mixed bacterial colonies that occurred in the previously exposed frontal sinus. The material in the frontal sinus was macroscopically similar to sinus fungus ball. Surgical strategy followed that for sinus fungus ball. The material could not be completely removed even with an endoscopic modified Lothrop procedure (Draf type III procedure). Additional external incision enabled complete removal of the remnant infectious substance...
2013: Case Reports in Otolaryngology
Calvin C Wei, Anshul Sama
PURPOSE OF REVIEW: Recent literature has described the use of mucosal grafts or transplants to reduce the rate of frontal ostium restenosis after the endoscopic-modified Lothrop procedure. This article presents a review of the literature on the rates of revision and restenosis related to Draf III procedures, factors implicated in the causation of restenosis and the evidence to support the role of mucosal grafts in reducing restenosis rates. RECENT FINDINGS: Compared to historic data and to the meta-analysis data by Anderson and Sindwani, results from three case series examining the use of mucosal flaps after endoscopic-modified Lothrop procedure look extremely promising compared to a baseline average stenosis rate of 19% and revision rate of 14% quoted in the literature...
February 2014: Current Opinion in Otolaryngology & Head and Neck Surgery
Jonathan Y Ting, Arthur Wu, Ralph Metson
OBJECTIVES/HYPOTHESIS: To determine the long-term results of frontal sinus drillout (also known as modified Lothrop procedure) for the treatment of advanced frontal sinus disease. STUDY DESIGN: Retrospective review. METHODS: The records of patients who underwent frontal sinus drillout by a single surgeon at an academic medical center from June 1995 through November 2011 were reviewed. Patient demographics and perioperative clinical findings were analyzed for their impact on surgical outcome...
May 2014: Laryngoscope
Yuresh Naidoo, Ahmed Bassiouni, Mark Keen, Peter J Wormald
OBJECTIVES/HYPOTHESIS: To detail the long-term outcomes of the endoscopic modified Lothrop procedure (EMLP) (also know as Draf III/frontal drillout) and identify key risk factors for failure. STUDY DESIGN: Retrospective cohort study and chart review. METHODS: Endoscopic assessment of frontal ostium patency and patient-reported symptoms were prospectively collected on patients who underwent EMLP between January 2001 and December 2011 for chronic rhinosinusitis (CRS)...
January 2014: Laryngoscope
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