Sinus problems are usually mostly cured by drug therapy and procedures such as flushing for treating sinusitis, but in case of ineffectiveness of the drug, recurrent infections or other complications such as structural abnormalities or fungal sinusitis, surgery to enlarge the openings that drain the sinuses is preferred.
Endoscopic sinus surgery is a minimally invasive, precise surgery using telescopes, micro-debrider and radio frequency treatment for acute and chronic sinus infections / headaches (children and adults), scarless blocked tear duct surgery, closure of brain fluid leakage, resection of sino-nasal tumors and nose bleeding. Until recently, the osteoplastic flap has been the standard surgical procedure but the Endoscopic Modified Lothrop Procedure (EMLP) is fast becoming a standard method for treating complications. Some of the benefits of EMLP over the osteoplastic flap procedure are decreased morbidity, improved cosmesis, and the ability to endoscopically evaluate patients postoperatively for recurrent disease. Other advantages include shorter hospitalization (usually the same day), less pain and reduced frontal and orbital oedema.
In recent years there has been a strong trend in surgery toward preservation of the mucoperiosteum of the sinuses and maintenance of a patent nasofrontal connection, in recognition of the fact that regenerating mucosa has a markedly diminished ciliary density that may never fully recover to its pre-operative level. In this respect, the endoscopic modified Lothrop procedure is a short-term management option for unmanageable and complicated front sinusitis caused by a wide range of diseases. It is a safe, successful and effective surgical alternative to osteoplastic flap and creates the largest anatomical opening possible to drain the frontal sinuses into the nasal cavity. As an endoscopic procedure, ELMP is less invasive and has lower blood loss compared to other procedures. It leaves no external scars and post operative surveillance is possible with CT and endoscopy scans.
EMLP is a frontal sinus drill-out that was developed in the mid 1990s and necessitates the removal of the inter frontal septum, the superior part of the nasal septum and the frontal sinus floor in a lateral direction. Pre-operative procedures include decongesting the nasal cavities with topical oxymetazoline and injection of the septum and the lateral nasal wall with 10ml of 1% lidocaine and 1:100,000 epinephrine solution. The surgery generally involves three procedures. A superior septa perforation is first created and 1cm of the anterior is removed from the middle turbinates. Next, one or both frontal recesses are identified and a bur is used to remove the frontal floor from the posterior to the anterior. Finally the surgeon moves across the midline and removes the bone to create the largest possible oval opening to both frontal sinuses.
The modified Lothrop procedure is very successful for chronic frontal sinus obstruction and now used for resection of osteomas and benign tumors such as inverted papillomas and their biggest advantage is their ability to directly inspect the sinus post-operatively for the tumor’s recurrence.
The Sinus Dallas Center, Texas ENT specialists and the McKinney ENT clinic in Texas possesses the state-of-the-art sinus treatments, including minimally invasive procedures such as the EMLP and is dedicated to provide specialized and personalized patient care.
As a whole, the modified Lothrop procedure has radically changed the management of frontal sinus syndrome.
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