Lothrop Procedure

I've had chronic sinusitis for a year and a half. I've been on too many different antibiotics and steroids, I've had two FESS and turbinate reduction surgeries during the past year, and for a month or so I would come to see my ENT doctor where he would basically vacuum my sinuses once or twice a week and apply anti-bacterial gel directly up there.

The surgeries have helped to an extent. The problem was originally in all of my sinuses on my left side. Now it is just my left frontal. I used to have terrible headaches and had trouble controlling the pain. Now I don't need pain killers and my nose is always clear. But I still have a LOT of dry congestion every single morning, which is hard to get out by blowing so I have to rely on the sinus rinse. I have post nasal drip and my nose bleeds almost every time I blow my nose.  And while I had the flu a few months ago it leaked like a tap non-stop out of my left nostril for a week after the flu subsided, which my doctor said I could expect more of if I don't get more treatment.

My body is just produce too much mucus over there and it is not draining.

So my ENT doctor has talked to another ENT doctor and they have scheduled me for a "Lothrop procedure". The two surgeons will perform it together, and they are both very experienced surgeons. He told me it involves drilling the bone to make a bigger opening, possibly removing a turbinate and part of the septum. Balloon sinuplasty is not an option because apparently my bones are too dense for the balloon to work.

It sounds a bit extreme to me, but the doctor keeps telling me that it is unlikely to have any side affects.

Has anyone heard of the Lothrop procedure? Is it worth giving it ago? Or should I just live with the symptoms?

[AndrewChapman200260]

I have never heard of the Lothrop procedure, but I have been through something similar.

I underwent sinus surgery on my left sinus in late 2002. On coming out of the aenesthetic it felt as through the ENT surgeon had took the side of my face off. The surgery was not successful - straightening a deviated septum plus removal of polyps.

The same ENT surgeon then sais that it was going to sort out the problem, once and for all, my drilling the drainage holes, and making them into 10p pieces rather than 5p pieces (UK currency) roughly twice the diameter.

The logic that larger holes would improve the drainage made sense, but I have since learn that the drainage holes are located at the TOP of the sinuses and work on SUCTION, so in effect by increasing the size, reduces suction not increases it !!!

I had the operation, and have never been the same since.

I have now developed nearly constant headaches, have to use a CPAP machine each and every night, as I stop breathing with Obstructive Sleep Apneoa, and now suffer constantly with pulsatile tinnitus.

I have also had further sinus surgery (FESS) to try and improve / correct the past surgery. Although, I can breath easier, still no SUCTION to left nostril.

Personally, I would consider everything very carefully before proceeding with the procedure.

[AndrewChapman200260]

http://www.docguide.com/salvage-frontal-sinus-surgery-endoscopic-modified-lothrop-procedure

Salvage frontal sinus surgery: the endoscopic modified lothrop procedure.

Endoscopic modified Lothrop procedure is effective for the short-term management of recalcitrant and complicated frontal sinusitis.

The procedure is an alternative to the osteoplastic flap with frontal sinus obliteration, which has the been the gold standard for recalcitrant frontal sinusitis, explains Dr Peter John Wormald from the Section of Otolaryngology Head and Neck Surgery at the Adelaide and Flinders Universities in Australia.

Dr Wormald conducted a prospective study of 83 consecutive patients who underwent the modified Lothrop procedure. Patients had undergone a mean of six previous sinus surgeries before the Lothrop procedure. Seventeen of the patients had previously undergone frontal sinus obliteration with mucocele formation.

A primary success rate of 93% was achieved after an average follow-up of 21.9

[AndrewChapman200260]

http://www.neurographics.org/Smith/6.shtml

Modified Lothrop Procedure (Draf III Procedure)

The modified Lothrop procedure, or Draf III procedure, may also be referred to as median drainage. This procedure, in its present form, was first described in the mid-1990s and has been gaining popularity among rhinologists. Indications include the most severe forms of chronic frontal sinusitis where osteoplastic flap with obliteration is the only alternative. This procedure involves removal of the inferior portion of the interfrontal septum, the superior part of the nasal septum, and the frontal sinus floor to the orbit laterally. The lamina papyracea and posterior walls of the frontal sinus remain intact. Postoperatively, a wide opening into both frontal sinuses can be seen. The surgical defect in the superior nasal septum should not be mistaken for an unintended postoperative septal perforation.