Abstract
Surgical management of refractory or recurrent frontal sinus disease poses a unique challenge for
endoscopic sinus surgeons due to complex and variable anatomy, difficulty in transnasal visualization, and a propensity for inadvertent scarring and restenosis. The endoscopic modified Lothrop procedure (EMLP) is an endoscopic procedure of frontal sinus surgery removing the frontal sinus floor, intersinus septum, and superior nasal septum. This procedure creates the largest possible opening from the floor of the frontal sinus into the nasal cavity for efficient drainage. We retrospectively analyzed 5 cases of frontal sinus lesion treated with EMLP in Kurashiki Central Hospital between 2011 and 2012. Except for one incidence of CSF leak, which was managed at the time of
surgery, no complications were observed during EMLP, such as tension pneumocephalus and posterior table dehiscence. All five patients reported symptomatic improvement and no reocclusion was seen after the surgery. The most notable postoperative problem is narrowing of the opening created due to regeneration of the bone tissue. This is likely prevented by maximally preserving mucosal membrane during the operation as well as by covering exposed bone surfaces with mucosal flap. Thus, although a larger sample size and more extensive follow-up would be necessary to make a general and definitive conclusion, we suggest that EMLP is efficacious in treating refractory or recurrent frontal sinus disease in a short period based on subjective symptom improvement and the need for further surgery.
