Modified subtotal lothrop procedure for extended frontal sinus and anterior skull base access: a cadaveric feasibility study with clinical correlates.
Objective The endoscopic modified Lothrop procedure (EMLP) is an established approach for recalcitrant frontal sinus disease and anterior skull base exposure. However, in select cases, this technique may involve unnecessary resection of sinonasal structures. In this study, we propose a modification of the EMLP, termed the modified subtotal-Lothrop procedure (MSLP), to access the anterior skull base and complex frontal sinus disease for which access to the bilateral frontal sinus posterior table is required. Methods A cadaveric dissection with photo documentation was performed at an academic medical center on four cadaver heads using standard endoscopic techniques to demonstrate the MSLP and its feasibility. Results The endoscopic MSLP allowed ample access for instrumentation in each of the dissections using a 30- or 70-degree endoscope. Adequate bilateral access to the posterior table of the frontal sinus was gained in all cases without the need for dissection of the contralateral frontal sinus recess (FSR). Conclusion The MSLP appears to be a feasible technique for exposure of the anterior skull base and accessing complex frontal sinus pathology. This modification provides similar anterior skull base exposure and surgical maneuverability as the EMLP while limiting surgical dissection to one FSR, thereby preserving as much of the natural mucociliary drainage pathways as possible.
Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, New Jersey, USA ; Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, New Jersey, USA ; Department of Neurological Surgery, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, New Jersey, USA.
Jean Anderson
JA
Eloy
Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, New Jersey, USA ; Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, New Jersey, USA ; Department of Neurological Surgery, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, New Jersey, USA.
James K
JK
Liu
Department of Neurological Surgery, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, New Jersey, USA.
Osamah J
OJ
Choudhry
Department of Otolaryngoogy, Head and Neck Surgery, Virginia Mason Medical Center, Seattle, Washington, USA.
Amy S
AS
Anstead
Division of Otolaryngology, Head and Neck Surgery Connecticut Sinus Institute, University of Connecticut, Farmington, Connecticut, USA.
Belachew
B
Tessema
Department of Otolaryngology-Head and Neck Surgery, Wayne State University, Detroit, Michigan, USA.
Adam J
AJ
Folbe
Department of Otolaryngology-Head and Neck Surgery, University of Miami, Leonard Miller School of Medicine, Miami, Florida, USA.
Roy R
RR
Casiano
Lothrop procedure; cadaveric technique; endoscopic modified Lothrop procedure; extended Draf IIB; modified hemi-Lothrop procedure; modified mini-Lothrop procedure; modified subtotal-Lothrop procedure