Potential conflict of interest: P.J.W. receives royalties from Medtronic ENT and is a consultant for NeilMed.
Risk factors and outcomes for primary, revision, and modified Lothrop (Draf III) frontal sinus surgery
Article first published online: 7 NOV 2012
© 2013 ARS-AAOA, LLC
International Forum of Allergy & Rhinology
Volume 3, Issue 5, pages 412–417, May 2013
How to Cite
How to Cite this Article: Risk factors and outcomes for primary, revision, and modified Lothrop (Draf III) frontal sinus surgery. Int Forum Allergy Rhinol, 2013; 3:412–417., , ,
Presented orally at the Annual ARS Meeting on September 8, 2012, Washington, DC.
- Issue published online: 17 MAY 2013
- Article first published online: 7 NOV 2012
- Manuscript Accepted: 28 AUG 2012
- Manuscript Revised: 9 AUG 2012
- Manuscript Received: 30 APR 2012
- endoscopic modified Lothrop procedure;
- frontal sinusotomy;
- endoscopic sinus surgery;
- risk factors
The purpose of this level 4, retrospective cohort study was to detail the outcomes of primary, revision, and endoscopic modified Lothrop procedure (EMLP) (Draf III) frontal sinus surgery and evaluate whether risk factors would help determine which patients would benefit from which procedures.
The study used a retrospective chart review. Endoscopic assessment of frontal ostium patency and patient reported symptoms were prospectively collected on patients who underwent frontal sinusotomy between January 2003 and December 2009. High-risk cohorts were studied to assess their response to standard endoscopic sinus surgery (ESS) compared with EMLP.
A total of 339 patients who met the inclusion and exclusion criteria underwent either primary or revision endoscopic frontal sinus surgery. The average ± standard deviation (SD) length of follow-up was 20.8 ± 18.7 (95% confidence interval [CI], 18.0–22.9) months. Postsurgical recurrence of disease with persistence of symptoms requiring an EMLP occurred in 9 patients in the primary group and 38 in the revision group. The highest risk groups for failure of standard frontal sinusotomy were patients with nasal polyps, asthma, Lund-Mackay score >16, and frontal ostium size <4 mm (relative risk = 9.9, p < 0.0001).
Patients with underlying asthma and polyposis as well as narrow frontal ostia and extensive radiological disease have a high failure rate from standard endoscopic frontal sinusotomy. In this patient group consideration should be given to offering the patient a primary EMLP procedure, which has excellent success rates with low risks and low morbidity.