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A Quick Anatomy Review of the Frontal Sinus

The modified Lothrop procedure is used to treat the affected frontal sinus surgically. The frontal sinus is an asymmetrical pair of moist air pockets above the eyebrows. It is separated by a bony partition called the inter-sinus septum. Each frontal sinus drains out through its opening, the frontonasal duct, which leads into the nasal cavity. 

All sinuses drain into the nasal cavity, which has soft tissue and bony structures that create pathways for airflow. For example, the nasal septum separates the nasal cavity vertically, making breathing on each nostril unilateral. 

When the frontal sinus is affected, the doctor may remove parts of these structures to widen the frontonasal ducts and improve drainage. One such procedure is the modified Lothrop. 

Understanding the Modified Lothrop Procedure

The initial Lothrop procedure is an open surgery in which the inter-sinus septum is removed. The surgeon also cuts out parts of the nasal septum and the bony partition between the nasofrontal ducts.

The modified Lothrop Procedure is completely internasal and shares the same goals. It’s a more minimally invasive procedure that creates an enlarged frontonasal cavity by removing the frontal sinus floor, inter-sinus septum, upper nasal septum, and the frontal beak of the inner skull.

This procedure uses an endoscope, a thin wire with a tiny light and camera on one end, to guide the doctor in resecting bones and tissues. The endoscope is inserted inside the nose with tiny surgical tools such as a soft-tissue shaver and bone-cutting drill.

Advantages of the Modified Lothrop Procedure

The modified Lothrop procedure shares the benefits of all endoscopic sinus surgical techniques.

Commonly, an Outpatient Procedure

The modified Lothrop procedure is commonly performed as an outpatient procedure. Depending on the state of the frontal sinus, the operation can take 1-3 hours to complete.

After surgery, the patients are placed in a recovery room for a few hours until they are well enough to go home.

No Scarring

Because it is endoscopic, modified Lothrop does not result in any facial scarring or changes to the shape of your nose.

A Modified Lothrop procedure involves inserting an endoscope and small surgical tools through your nose. Because the endoscope’s light and camera guide the doctor, they can improve the frontal sinus opening without open surgery.

However, some scar tissue may develop inside the nose. This concern is solved with post-operative follow-up visits for necessary scar tissue removal under local anesthesia.

Excellent Frontal Sinus Visualization Post-Operation

In a 2018 retrospective review, 84% of patients who underwent the modified Lothrop procedure sustained expansion of the widened frontonasal ducts. The expansion was graded endoscopically after each post-operative visit. Those who suffer from partial or closed openings post-operation are caused by scarring effects of persistent inflammation from their conditions, such as chronic rhinitis and nasal polyps.

High Cure Rate for Chronic Frontal Sinusitis

In the same review, 78% of patients require no further revision surgery after undergoing a modified Lothrop procedure. 90% of the patients reported “significant clinical improvement” at the latest recorded follow-up.

Those who are more likely to require revision surgery are those with the presence of inflamed tissue, often from reoccurring conditions, with the majority of the patients suffering from chronic rhinitis.

Surgical Indications: Who Can Benefit from the Modified Lothrop Procedure

The modified Lothrop procedure can reduce the number of surgeries for people with severe chronic sinusitis. According to the same review, those with oral mucus cysts and tumors can also benefit from this resection procedure. By removing the affected parts and widening the frontonasal ducts, patients can experience improved Quality of life. 

Expertise at Puget Sound Sinus Center

The modified Lothrop procedure is a minimally invasive surgical procedure for the affected frontal sinus. This outpatient procedure only takes a few hours and leaves no external scarring. It also has a high surgical success rate in sustained expanded openings and symptom improvement. It’s important to be in capable hands when undergoing this procedure. Dr. Amy Anstead, a seasoned skull-based surgeon at Puget Sound Sinus Center, offers decades of expertise. https://www.kondimonta.lt/produktai/kategorija/silumos-siurbliai/ Šilumos siurbliai ir kondicionieriai Experience personalized, holistic care with us. Schedule your appointment today for sinus relief and a clearer head.

Click below to learn more. Dr. Amy Anstead | Modified Lothrop Procedure

Sphenoidotomy is vital for many reasons. It is utilized to remove infected tissue, access and excise tumors, and decongest sphenoid sinuses. If you’re considering this procedure, here are the seven signs that indicate you need one.

What Is a Sphenoidotomy?

A sphenoidotomy is a surgical procedure aimed at enlarging the opening of the sphenoid sinus. It can involve the surgical removal of infected tissue. It can also vary in approach based on the patient’s specific medical condition.

7 Signs You May Need Sphenoidetomy

1. Conservative Treatment is Not Effective to Your Vasomotor Rhinitis 

Vasomotor rhinitis is characterized by inflammation of nasal passages due to non-allergens like smoking, the cold, stress, or air pollution. If medicine has little to no effect on your vasomotor rhinitis, your healthcare provider may recommend endonasal vivian neurectomy.

Endonasal vivian neurectomy is a surgical procedure to numb the nerve that triggers vasomotor rhinitis. Sphenoidotomy is often incorporated into this procedure to alleviate rhinitis symptoms effectively.

2. Conservative Treatment is Not Effective to Your Sphenoid Rhinosinusitis

Sphenoid rhinosinusitis is the inflammation of the sphenoid sinuses and nasal lining.

Rhinosinusitis is inflammation of the sinuses and the lining inside your nose. If traditional remedies like medication and saline irrigation prove ineffective in alleviating symptoms, your healthcare provider may suggest sphenoidotomy. Through sphenoidotomy, your sinus surgeon can remove infected tissue and improve nasal airflow.

3. There is a Mass or Lesion in Your Sphenoid Sinus

Discovering a mass or lesion within the sphenoid sinus can indicate a tumor, which can cause various symptoms.

A growth in the sphenoid sinus can cause long-term or chronic nose congestion, making breathing or smelling difficult. The tumor can also cause pus or blood to drip from the nose. Additionally, the tumor’s presence may exert pressure on nearby nerves, resulting in sensations of numbness or pain in the face, teeth, or ears.

Sphenoidotomy offers a solution to address these issues. It allows your healthcare provider to remove the lesions effectively, relieving your sphenoid sinuses from the associated symptoms and restoring their function.

4. You’re Having Vision Problems

Did you know that approximately 90% of sphenoid sinuses contact the ipsilateral optic nerve, while 10% contact both nerves?

Congestion within the sphenoid sinus can exert pressure on the optic nerve, resulting in blindness, loss of color vision, and pain.

Expanding the opening of the sphenoid sinus through sphenoidotomy facilitates drainage of congestion, thereby alleviating pressure on the optic nerve and improving vision.

5. You Have a Sphenoid Cerebrospinal Fluid Leak

Sphenoid cerebrospinal fluid (CSF) leaks can be congenital, traumatic, tumor-related, or idiopathic.

Approximately 26% of non-traumatic CFL leaks occur with defects in the sphenoid sinus.

For traumatic CSF leaks, 29% result in meningitis in the long term when not surgically repaired.

In such cases, a sphenoidotomy is essential to access and repair the leak, preventing further complications.

6. You Have Pituitary Tumors 

The pituitary gland is at the brain’s base above the nasal cavity. Large pituitary tumors can press on the pituitary gland, brain, and nerves, causing headaches, vision problems, and even seizures.

For a non-invasive surgical removal of these pituitary tumors, sphenoidotomy is crucial.

7. You Have Tumors on the Base of Your Skull

Skull-based tumors can Impact the cranial nerves responsible for sensory and motor functions, including sight, taste, smell, hearing, and facial muscle control. When these tumors impinge on cranial nerves, they may lead to blindness, hearing loss, and an altered sense of taste and smell.

Located at the bottom of the skull, these tumors can be addressed through endonasal skull-based surgery via the nasal passage. Accessing these tumors necessitates the opening of the sphenoid sinus through a sphenoidotomy, allowing the surgeon to remove the tumors and restore normal function effectively.

What to Do Next: Finding a Sinus Specialist

Sphenoidotomy is typically recommended when conservative treatments yield inadequate results or when symptoms, such as vision impairment, escalate.

In some instances, sphenoidotomy is incorporated into broader surgical interventions to access specific regions within the body.

If you exhibit any of the signs mentioned above, consulting a sinus specialist or surgeon is essential. At Puget Sound Sinus Center, you’ll find a dedicated sinus specialist with extensive experience in successful surgeries. Dr. Amy Anstead is the only sinus specialist globally to complete a second Integrative Medicine fellowship. She offers evidence-based and holistic care for sinus and skull base conditions. Take the first step toward relief by scheduling an appointment with us today.

Dr. Amy Anstead | Sphenoidotomy