title: Modified mini-Lothrop/extended Draf IIB procedure for contralateral frontal sinus disease: a case series.
abstract: BACKGROUND
  Management of frontal sinus disease represents one of the most challenging aspects of endoscopic sinus surgery. In select cases, anatomic variations (outflow tract osteoneogenesis, scarring, fat prolapsed from previous orbital decompression) may hinder ipsilateral access using traditional endoscopic approaches. We previously proposed a modification of the standard Draf IIB procedure which incorporates a frontal intersinus septectomy (modified mini-Lothrop procedure/extended Draf IIB) to access and manage recalcitrant unilateral frontal sinus obstruction inaccessible ipsilaterally in cadaver specimens. In this study, we describe this technique, and present a case series of 4 patients who benefited from this approach.
  
  
  METHODS
  A retrospective analysis at a large tertiary referral center was performed on all patients undergoing frontal sinus surgery between July 2008 and June 2011. Four patients with frontal sinus recess obstruction inaccessible from the ipsilateral side and treated with the modified mini-Lothrop procedure/extended Draf IIB were identified.
  
  
  RESULTS
  All 4 patients underwent successful frontal sinusotomies via a Modified mini-Lothrop procedure/extended Draf IIB without complications and had a patent drainage pathway assessed endoscopically after a mean follow-up of 21 (range, 9-28) months.
  
  
  CONCLUSIONS
  The modified mini-Lothrop procedure/extended Draf IIB represents a feasible approach and adequate alternative to more traditional endoscopic and open frontal sinus procedures in select cases. This modification was successful in addressing difficult to access unilateral frontal sinus disease in this small cohort.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, NJ 07103, USA. jean.anderson.eloy@gmail.com
authors.forename: Jean Anderson
authors.initials: JA
authors.lastname: Eloy
authors.forename: Mark E
authors.initials: ME
authors.lastname: Friedel
authors.forename: Arjuna B
authors.initials: AB
authors.lastname: Kuperan
authors.forename: Satish
authors.initials: S
authors.lastname: Govindaraj
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Folbe
authors.forename: James K
authors.initials: JK
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004724:Endoscopy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005626:Frontal Sinus / Q000033:anatomy & histology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015508:Nasal Obstruction / Q000601:surgery*; D009300:Nasal Septum / Q000033:anatomy & histology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome