A systematic review of endoscopic modified Lothrop procedure for the treatment of chronic frontal sinusitis

Scott NA, Wormald PJ, Close D, Gallagher R, Anthony A, Maddern GJ
Record ID 32002000436
Authors' objectives:

The aim of this review was to compare the safety and efficacy of the endoscopic modified Lothrop procedure (EMLP), performed either wholly intranasally or in combination with an external approach, against the current benchmark treatment, the osteoplastic flap procedure with or without fat obliteration (OPF).

Authors' results and conclusions: The limited comparative data suggested that EMLP caused fewer adverse postoperative outcomes but was more likely to generate a perioperative cerebrospinal fluid leak than OPF. However, none of the morbidity traditionally associated with OPF was evident following EMLP. EMLP appeared to have a shorter operative time and a lower perioperative blood loss than OPF, but little could be determined regarding the long term efficacy and durability of EMLP because of the relatively short follow-up of the majority of the studies.
Authors' recomendations: The Review Group concluded that the evidence base for EMLP was inadequate and recommended that EMLP for the treatment of chronic frontal sinusitis be given a classification of '2'. That is, the safety and efficacy of the procedure cannot be determined at the present time due to an incomplete and poor quality evidence-base. It was recommended that a national audit, with standardised data reporting, of the centres currently performing the procedure be conducted to establish safety and efficacy. The Otolaryngology Head and Neck Surgeons of the Royal Australasian College of Surgeons would ideally manage this, and any new centres embarking on the use of EMLP would be recruited into the audit. A concurrent national audit of the osteoplastic flap procedure was also recommended. In addition, the following clinical recommendations were made to guide the development of EMLP during this audit phase: 1. Otolaryngological surgeons should obtain institutional support and appropriately inform their patients before commencing EMLP. 2. EMLP is a technically demanding procedure. Therefore, EMLP should only be performed on appropriately selected patients by a properly trained otolaryngological surgeon who is accredited in the use of the procedure. Before performing EMLP, the surgeon should participate in a formal training workshop that includes surgical theory, endoscopic anatomy, and cadaver dissection. A minimum prescribed number of cadaver dissections and supervised surgical procedures should be performed before full accreditation is awarded.
Authors' methods: Systematic review
Project Status: Completed
Year Published: 2001
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: Australia
MeSH Terms
  • Chronic Disease
  • Endoscopy
  • Frontal Sinusitis
Organisation Name: Australian Safety and Efficacy Register of New Interventional Procedures-Surgical
Contact Address: ASERNIP-S PO Box 553, Stepney SA 5069 Australia Tel: +61 8 8363 7513; Fax: +61 8 8362 2077;
Contact Name: college.asernip@surgeons.org
Contact Email: college.asernip@surgeons.org
Copyright: Australian Safety and Efficacy Register of New Interventional Procedures - Surgical (ASERNIP-S)
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