Objectives/Hypothesis:
The endoscopic modified Lothrop procedure (EMLP; also known as Draf III or frontal drillout) has recently gained popularity as a minimally invasive alternative to frontal sinus ...obliteration. This systematic analysis was designed to assess the safety and efficacy of the EMLP.
Study Design:
Literature review and meta‐analysis.
Methods:
We performed a search of all English studies published from 1990 to 2008 that reported results from a minimum of five patients undergoing the EMLP. Of the 33 papers reviewed, 18 studies (evidence level II‐2 or II‐3) containing data from 612 patients met inclusion criteria.
Results:
The most common indications for EMLP were chronic frontal sinusitis (75.2%) and mucocele (21.3%). Patients had an average age of 47.9 years (range, 14–89 years) and were followed for 28.5 months postoperatively. Only 20.3% of procedures were performed without image‐guidance. Stents were rarely used (6%). The rate of major and minor complications was <1% and 4%, respectively. No deaths were reported. A majority of patients were discharged within 24 hours. Postoperative endoscopic findings, qualitatively reported in 394 patients, demonstrated frontal sinus patency or partial stenosis in 95.9% at last follow‐up. Where specifically assessed (n = 430 patients), improvement in symptoms was achieved in 82.2% of cases, with 16% reporting no significant change, and 1.2% reporting worsening of symptoms. The overall failure rate (requiring further surgery) of EMLP was 13.9% (85/612). Of the failures, 80% underwent revision EMLP, whereas 20% elected osteoplastic frontal sinus obliteration.
Conclusions:
When performed by an experienced surgeon, EMLP is a safe and efficacious procedure that is well tolerated. Laryngoscope, 2009
Vasomotor rhinitis (VMR) is one of the most prevalent forms of nonallergic rhinitis. In the past, when maximal medical therapy failed, surgical options were limited. Vidian neurectomy (VN) was one ...option; however, it was fraught with complications and limited success. The advent of endoscopic sinus surgery revitalized interest in surgical procedures for VMR. This study was designed to review the available literature and assess the safety and efficacy of surgery on the vidian and posterior nasal nerves for treatment of VMR and when possible, compare the different approaches to one another in regard to safety and efficacy.
A systematic review was performed of English language articles using Ovid and PubMed. Search terms included "endoscopic vidian neurectomy," "vidian neurectomy," "endoscopic posterior nasal neurectomy" (EPNN), and "posterior nasal neurectomy." Only clinical trials performed on humans with safety and or efficacy data were included. Independent extraction of articles by two authors using predefined data fields was performed. Safety defined by complication rates and efficacy defined as objective improvement on outcomes scores along with the overall length of benefit were the primary measures of treatment effect. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement for reporting systematic reviews was followed.
In comparison with open VN, endoscopic techniques were not associated with any long-term sequelae. Rhinorrhea and nasal obstruction were shown to improve after endoscopic VN (EVN) and the benefits were maintained for several years after surgery.
EVN is well tolerated, safe, and effective in a majority of patients. Overall, the literature has shown that the endoscopic approach is associated with less morbidity than the traditional transantral approach. Currently, no literature exists on the effect of EPNN in patients with vasomotor rhinitis and further study is needed to elucidate the efficacy of this procedure in this subset of patients.
Surgical techniques for managing inferior turbinate hypertrophy (ITH) vary widely and have evolved substantially in the past four decades as new technologies have emerged.
Literature review.
Inferior ...turbinate (IT) procedures can be categorized as: simple turbinate outfracture; turbinoplasty techniques such as extramucosal destruction, and submucosal tissue removal; and extramural turbinate resection (partial or complete). Each of these approaches has advantages and drawbacks. Considerations for technique selection include clinical setting (in-office versus operating room), cost of the devices used, efficacy of the procedure to relieve nasal obstruction, and minimizing postoperative complications such as nuisance bleeding, adhesion formation, and crusting.
There are a variety of contemporary surgical techniques used for IT reduction. This article highlights the available literature and gaps in current knowledge. A graduated approach to the management of ITH will be presented.
The pituitary gland plays a vital role in hormonal regulation. Pituitary lesions include tumors, cysts, and inflammatory processes that require multidisciplinary care from endocrinologists, ...neuro-ophthalmologists, neurosurgeons, and otolaryngologists. Treatment is typically aimed at controlling hormonal hypersecretion, decompressing the optic apparatus, and reducing tumor volume, and surgery is a common first-line approach. In this article, we provide a background on the function of the pituitary gland, common pituitary lesions, and their clinical presentations, as well as a summary of the history and physical, laboratory testing, and imaging required for the workup of a pituitary lesion.
This article provides a review of contemporary techniques in nasal septal surgery. Relevant anatomy and physiology of the nose and nasal septum are discussed. The essentials of a complete diagnostic ...evaluation are outlined. The evolution of surgical approaches to the correction of a deviated septum, including classic submucosal resection, traditional septoplasty, and open techniques, is covered. Complications of septoplasty are reviewed, with an emphasis on prevention and treatment. The recently popularized endoscopic septoplasty, a significant advance in septal surgery, is addressed elsewhere in this issue.
