MODIFIED TRANSNASAL ENDOSCOPIC LOTHROP PROCEDURE AS AN ALTERNATIVE TOFRONTAL-SINUS OBLITERATION

Persistent frontal sinusitis traditionally has been treated with exter nal procedures such as osteoplastic frontal sinus obliteration or the Lynch procedure. currently functional endoscopic sinus surgery can be used in most cases to remove disease from the frontal recess, the most frequent site of frontal sinus obstruction, thereby relieving the sin usitis, In some cases, however, frontal recess exploration has failed to relieve the obstruction of the frontal sinus, necessitating an oste oplastic frontal sinus obliteration. We present our experience with a transnasal modification of the Lothrop procedure. The Lothrop procedur e, first described in 1914, uses a combined external and transnasal ap proach to resect the median frontal sinus floor, superior nasal septum , and intersinus septum to drain the frontal sinus. This procedure was largely abandoned and forgotten by modern otolaryngologists. However, with the advent of the computed tomography scan and endoscopic techni ques, we sought to reassess the basic tenant of the Lothrop procedure (i.e., wide median frontal sinus drainage). An anatomic study of cadav er heads was performed to quantify the surprisingly large potential op ening and to better understand the pertinent anatomy. This procedure w as performed on 10 patients, with no resulting complications and no fa ilure to maintain patency of the frontal sinus drainage throughout the follow-up period (mean, 7 months). We are encouraged by our initial f avorable results and intend to use the procedure in the future as need s arise.