1531-4995/asset/cover.gif?v=1&s=ac9e987508d442acd12556b278c60cf12b627a2e "The Laryngoscope")
Presented at the Triological Society Combined Southern and Middle Sections Meeting, Bonita Springs, Florida, U.S.A., January 8–11, 2009.
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Original Study
Safety and efficacy of the endoscopic modified Lothrop procedure: A systematic review and meta-analysis†‡
Article first published online: 24 JUN 2009
DOI: 10.1002/lary.20565
Copyright © 2009 The American Laryngological, Rhinological, and Otological Society, Inc.
Additional Information
How to Cite
Anderson, P. and Sindwani, R. (2009), Safety and efficacy of the endoscopic modified Lothrop procedure: A systematic review and meta-analysis. The Laryngoscope, 119: 1828–1833. doi: 10.1002/lary.20565
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Winner of the 1st Place Research Poster Prize.
Publication History
- Issue published online: 27 AUG 2009
- Article first published online: 24 JUN 2009
- Manuscript Accepted: 5 MAY 2009
- Abstract
- Article
- References
- Cited By
Keywords:
- Endoscopic modified Lothrop procedure;
- endoscopic frontal drill out;
- Draf III procedure;
- frontal sinusitis;
- outcomes
Abstract
Objectives/Hypothesis:
The endoscopic modified Lothrop procedure (EMLP; also known as Draf III or frontal drillout) has recently gained popularity as a minimally invasive alternative to frontal sinus obliteration. This systematic analysis was designed to assess the safety and efficacy of the EMLP.
Study Design:
Literature review and meta-analysis.
Methods:
We performed a search of all English studies published from 1990 to 2008 that reported results from a minimum of five patients undergoing the EMLP. Of the 33 papers reviewed, 18 studies (evidence level II-2 or II-3) containing data from 612 patients met inclusion criteria.
Results:
The most common indications for EMLP were chronic frontal sinusitis (75.2%) and mucocele (21.3%). Patients had an average age of 47.9 years (range, 14–89 years) and were followed for 28.5 months postoperatively. Only 20.3% of procedures were performed without image-guidance. Stents were rarely used (6%). The rate of major and minor complications was <1% and 4%, respectively. No deaths were reported. A majority of patients were discharged within 24 hours. Postoperative endoscopic findings, qualitatively reported in 394 patients, demonstrated frontal sinus patency or partial stenosis in 95.9% at last follow-up. Where specifically assessed (n = 430 patients), improvement in symptoms was achieved in 82.2% of cases, with 16% reporting no significant change, and 1.2% reporting worsening of symptoms. The overall failure rate (requiring further surgery) of EMLP was 13.9% (85/612). Of the failures, 80% underwent revision EMLP, whereas 20% elected osteoplastic frontal sinus obliteration.
Conclusions:
When performed by an experienced surgeon, EMLP is a safe and efficacious procedure that is well tolerated. Laryngoscope, 2009