Modified subtotal-Lothrop procedure for extended frontal sinus and anterior skull-base access: a case series.

BACKGROUND: The endoscopic modified Lothrop procedure (EMLP) is well established for resistant frontal sinus disease and anterior skull base (ASB) exposure. However, this technique may be unnecessarily aggressive by removing avoidable sinonasal structures in select cases. Previously, in a cadaveric study, we proposed a modification of the EMLP, termed the modified subtotal-Lothrop procedure (MSLP), to access the ASB and to address complex frontal sinus disease, for which access to the bilateral frontal sinus posterior table is required. This study provides a step-by-step description of this technique, and presents our experience in 5 patients who underwent this approach.

METHODS: A retrospective analysis was performed at a tertiary referral center on all patients undergoing endoscopic ASB resection and complex frontal sinus surgeries between May 2011 and May 2013. Of 8 patients identified who underwent an MSLP, 5 had at least 1-year follow-up.

RESULTS: All patients underwent successful ASB exposure via the MSLP without complications and preservation of one frontal sinus recess. Adequate access to the bilateral posterior frontal sinus table was achieved in all cases. A patent frontal sinus drainage pathway could be assessed endoscopically after a mean follow-up of 18.6 (range, 12-27) months.

CONCLUSION: The MSLP is a feasible approach for exposure of the ASB and accessing complex frontal sinus pathology. This modification provides adequate ASB exposure and surgical maneuverability similar to the EMLP, while preserving one frontal sinus recess. This modification was successful in providing adequate exposure and maneuverability as well as maintaining frontal sinus patency in this small cohort.