Modified endoscopic lothrop as a salvage for the failed osteoplastic flap with obliteration.
OBJECTIVE
To evaluate the effectiveness of the modified endoscopic Lothrop (MEL) procedure for the management of failed osteoplastic flap (OPF) with obliteration of the frontal sinuses.


METHODS
Adelaide University Academic Hospital Complex.


METHODS
Prospective case study of 16 patients presenting with symptoms after OPF with obliteration of the frontal sinuses.


METHODS
Sixteen patients presented with symptoms of frontal sinus pain after having previously undergone OPF and fat obliteration of the frontal sinuses. All patients underwent computed tomography scanning; 13 underwent magnetic resonance imaging scanning, and 6 underwent a bone scan with technetium to exclude frontal osteitis. All patients underwent exploration of the frontal sinuses by way of the MEL procedure.


RESULTS
Fifteen patients were found to have a frontal sinus mucocele, whereas one patient had no mucocele with only new bone and fibrous tissue found at the MEL procedure. Twelve of the 16 patients with mucoceles had resolution of their frontal headaches, with 15 having a patent and healthy communication between the mucocele and the nasal cavity. The one patient without a mucocele continues to have frontal pain. One patient underwent a successful MEL procedure but had persistent symptoms until a supraorbital ethmoid mucocele was removed at a revision procedure. Two other patients continued to have frontal headaches and pain despite a healthy ostium into the frontal sinus mucocele.


CONCLUSIONS
MEL is a viable alternative to revision OPF for symptomatic patients who are shown to have a mucocele of the frontal sinuses.
Wormald
Peter John
PJ
Department of Surgery, Otolaryngology Head and Neck Surgery, Adelaide University, South Australia, Australia. peterj.wormald@adelaide.edu.au
Ananda
Arjuna
A
Nair
Salil
S
D000328:Adult; D000368:Aged; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005626:Frontal Sinus / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009078:Mucocele / Q000175:diagnosis* / Q000601:surgery*; D010254:Paranasal Sinus Diseases / Q000175:diagnosis* / Q000601:surgery*; D011446:Prospective Studies; D016879:Salvage Therapy / Q000379:methods; D013524:Surgical Flaps; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure