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International Forum of Allergy & Rhinology

Modified subtotal-Lothrop procedure for extended frontal sinus and anterior skull-base access: a case series

Authors

  • Jean Anderson Eloy MD, FACS,

    Corresponding author
    1. Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ
    2. Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ
    3. Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ
    • Correspondence to: Jean Anderson Eloy, MD, FACS, Rhinology and Sinus Surgery, Endoscopic Skull Base Surgery Program, Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, 90 Bergen St., Suite 8100, Newark, NJ 07103; e-mail: jean.anderson.eloy@gmail.com

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  • Leila J. Mady PhD,

    1. Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ
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  • Vivek V. Kanumuri BS,

    1. Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ
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  • Peter F. Svider MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI
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  • James K. Liu MD

    1. Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ
    2. Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ
    3. Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ
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  • Potential conflict of interest: None provided.

  • Presented at the 59th Annual ARS Meeting on September 28, 2013, Vancouver, BC, Canada.

Abstract

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. This study provides a step-by-step description of this technique, and presents our experience in 5 patients who underwent this approach.

Methods

A retrospective analysis was performed at a tertiary referral center on all patients undergoing endoscopic ASB resection and complex frontal sinus surgeries between May 2011 and May 2013. Of 8 patients identified who underwent an MSLP, 5 had at least 1-year follow-up.

Results

All patients underwent successful ASB exposure via the MSLP without complications and preservation of one frontal sinus recess. Adequate access to the bilateral posterior frontal sinus table was achieved in all cases. A patent frontal sinus drainage pathway could be assessed endoscopically after a mean follow-up of 18.6 (range, 12–27) months.

Conclusion

The MSLP is a feasible approach for exposure of the ASB and accessing complex frontal sinus pathology. This modification provides adequate ASB exposure and surgical maneuverability similar to the EMLP, while preserving one frontal sinus recess. This modification was successful in providing adequate exposure and maneuverability as well as maintaining frontal sinus patency in this small cohort.

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