Long-term outcomes for the endoscopic modified Lothrop/Draf III procedure: a 10-year review.

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). Risk factors for failing EMLP were identified.

RESULTS: There were 229 patients who met the inclusion and exclusion criteria and underwent an EMLP. The average number of standard endoscopic sinus surgery procedures prior to an EMLP was 3.8 (95% confidence interval [CI]: 3.4-4.2, standard deviation [SD]: 3.3).The average length of follow-up was 45.0 months (95% CI: 41.2-48.9 months, SD: 22.3 months). The EMLP was successful in 95% (217/229), with no further surgery being required. Postsurgical recurrence of disease with persistence of symptoms requiring revision EMLP occurred in 12 patients. No complications were identified. Allergic fungal sinusitis and recurrent Staphylococcus aureus infections were identified as potential risk factors for failure.

CONCLUSIONS: This is the single largest study of EMLP in the literature with a long follow-up period. It illustrates the benefit of the EMLP for patients with CRS recalcitrant to medical and standard endoscopic sinus surgery.