Endoscopic modified Lothrop procedure for the treatment of chronic frontal sinusitis: a systematic review

We sought to assess the safety and efficacy of the endoscopic modified Lothrop procedure (EMLP), performed either wholly intranasally or in combination with an external approach, against the osteoplastic flap (OPF) procedure with or without fat obliteration.

All original, published studies on the EMLP and the OPF, with or without fat obliteration, were identified by searching Current Contents, Embase, MEDLINE, and The Cochrane Library. The search strategy for OPF was date-restricted to articles published after 1979 until February 2001. For both EMLP and OPF, only studies of patients diagnosed with chronic frontal sinusitis were included for review. English-language reports detailing randomized controlled trials, controlled clinical trials, case series, or case reports were included.

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 after 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.

The evidence base for EMLP was deemed inadequate to assess its safety and efficacy, and an audit of the procedure was recommended. Additional clinical recommendations were made regarding the development and current practice of EMLP during this audit phase.