Presented at the Triological Society Combined Southern and Middle Sections Meeting, Bonita Springs, Florida, U.S.A., January 8–11, 2009.
Article first published online: 24 JUN 2009
Copyright © 2009 The American Laryngological, Rhinological, and Otological Society, Inc.
Volume 119, Issue 9, pages 1828–1833, September 2009
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
Winner of the 1st Place Research Poster Prize.
- Issue published online: 27 AUG 2009
- Article first published online: 24 JUN 2009
- Manuscript Accepted: 5 MAY 2009
- Endoscopic modified Lothrop procedure;
- endoscopic frontal drill out;
- Draf III procedure;
- frontal sinusitis;
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.
Literature review and meta-analysis.
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.
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.
When performed by an experienced surgeon, EMLP is a safe and efficacious procedure that is well tolerated. Laryngoscope, 2009