Persistent frontal sinusitis traditionally has been treated with external procedures such as osteoplastic frontal sinus obliteration or the Lynch procedure. Currently, functional endoscopic sinus surgery can be used in most cases to remove disease from the frontal recess, the most frequent site of frontal sinus obstruction, thereby relieving the sinusitis. In some cases, however, frontal recess exploration has failed to relieve the obstruction of the frontal sinus, necessitating an osteoplastic frontal sinus obliteration. We present our experience with a transnasal modification of the Lothrop procedure. The Lothrop procedure, first described in 1914, uses a combined external and transnasal approach to resect the median frontal sinus floor, superior nasal septum, and intersinus septum to drain the frontal sinus. This procedure was largely abandoned and forgotten by modern otolaryngologists. However, with the advent of the computed tomography scan and endoscopic techniques, we sought to reassess the basic tenant of the Lothrop procedure (i.e., wide median frontal sinus drainage). An anatomic study of cadaver heads was performed to quantify the surprisingly large potential opening and to better understand the pertinent anatomy. This procedure was performed on 10 patients, with no resulting complications and no failure to maintain patency of the frontal sinus drainage throughout the follow-up period (mean, 7 months). We are encouraged by our initial favorable results and intend to use the procedure in the future as needs arise.

Modified Transnasal Endoscopic Lothrop Procedure as an Alternative to Frontal Sinus Obliteration

The modified Lynch operation (Neel-Lake) differs in several ways from the operation described by Lynch. The operation begins with an intranasal anterior ethmoidectomy. The agger nasi cells are removed by curetting forward between the frontal process of the maxilla and the septum. The middle turbinate, normal-appearing mucosa of the frontal-ethmoid complex, and frontal process of the superior maxilla are preserved. Bone removal is limited in most cases to the anterior floor of the frontal sinus, a portion of the lacrimal bone, and the bone over the anterior ethmoid cells. Another important difference is the use of soft, nonreactive material (thin Silastic® sheeting) to stent the nasal-frontal passageway. Removal of all the mucosa of the frontal-ethmoid-sphenoid complex is unnecessary for a good postoperative result, and the remaining normal mucosa hastens the process of reepithelialization of the nasal-frontal duct.

The patients in our original study group have been observed for a period of 5 to 20 years (mean, 13.5 years) after the surgical procedure. This is the longest period of follow-up for any group of patients reported in the literature. The incidence of failures increased from 7% (one duct) to 20% (3 of 15 ducts) after an additional 7 years of follow-up.

https://onlinelibrary.wiley.com/doi/pdf/10.1288/00005537-198711000-00005

Modified Lynch procedure for chronic frontal sinus diseases: rationale, technique, and long-term results.

Twenty-eight patients received surgical treatment for a paranasal sinus mucocele with intracranial and/or intraorbital extension. The lesions were classified by site and extension: anterior without intracranial extension (Type 1), 7 patients; anterior with intracranial extension (Type 2), 11 patients; posterior midline without intracranial extension (Type 3), 5 patients; and posterior with intracranial extension (Type 4), 5 patients. The surgical approaches were: transnaso-orbital, transfrontonaso-orbital, transsphenoidal, transmaxillosphenoidal, and subfrontal transbasal; the choice depended on the site and extension of the lesion, with the aim of securing maximum exposure to ensure total removal of the lesion with its capsule. A transcranial approach was reserved for mucoceles possessing an intracranial extension or causing distension of the bone structures with optic pathway neurological symptoms. With a coronal or transfacial skin incision along the lines of the forehead, nose, and orbital muscles of expression and careful reconstruction, the patients' natural cast of features was spared or restored in a single operation.

Mucoceles of the paranasal sinuses with intracranial and intraorbital extension: Report of 28 cases

Mucocoeles of the paranasal sinuses are relatively uncommon and in the past have been generally treated by an external surgical approach. Forty-eight mucocoeles in the frontal, fronto-ethmoidal and sphenoidal sinuses have been treated during the last five years, 20 by an entirely endonasal endoscopic approach and 28 by a combination of an external procedure and an endoscopic approach. There were no recurrences in the endoscopic group, with a mean follow-up of 34 months whilst three recurrences occurred in the combined external and endoscopic group which had a mean follow-up of 44 months. This may reflect the complexity and severity of concomitant disease. If a wide marsupialization can be achieved by an entirely endoscopic approach there are a number of advantages, notably a lack of facial scarring in children and young adults.

Endoscopic management of paranasal sinus mucocoeles.

Paranasal sinus mucocele is a benign pseudocystic lesion, which may originate from any of the sinus cavities. Although the diagnosis may be suggested by the clinical presentation, CT is necessary to accurately analyze the regional anatomy and extent of the lesion. MRI is helpful in defining the limited unusual lesions occurring in critical areas. Standard treatment is surgical marsupialization, through endonasal sinus surgery, which offers a conservative, minimally invasive approach, and respects the sinus architecture and natural drainage. Our long-term experience with the endonasal endoscopic approach for the treatment of mucoceles led us to subsequently expand our indications to include most mucoceles, either as the sole approach or associated with an external approach. Comprising the surgical experience of two collaborating universities, this paper describes the indications for the endonasal surgical approach and the long-term postoperative followup.

Surgical Management of Paranasal Sinus Mucoceles: A Long-Term Study of 60 Cases

• The treatment of mucoceles by the Lynch-Howarth frontoethmoidectomy has been criticized because of a high rate of recurrence and postoperative complications. The long-term results in 60 patients treated by this method are examined to evaluate these criticisms. Compared with the osteoplastic flap—obliterative procedure, our results suggest a much lower recurrence rate (4%) and considerably better cosmesis with frontoethmoidectomy. This is achieved by the use of a fenestrated Silastic drainage tube left in place for five months and careful positioning of the scar. The criticisms would appear to be unjustified, and these results lend support to the continued use of the Lynch-Howarth procedure in the treatment of frontoethmoidal mucoceles. ( Arch Otolaryngol Head Neck Surg 1986;112:434-436)

Frontoethmoidectomy in the Treatment of Mucoceles: A Neglected Operation

in the Treatment of Mucoceles

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Frontoethmoidectomy in the Treatment of Mucoceles: A Neglected Operation

in the Treatment of Mucoceles