Combined approach intranasal endoscopic and external Lothrop procedure in chronic frontal sinus disease

The endoscopic approach to the fronto-ethmoidal recess (FER) in the treatment of chronic frontal sinus disease is now widely accepted. The Lothrop procedure was first described in 1914, but was largely replaced with more invasive open frontal sinus procedures until the advent of the rigid Hopkins' rod, since when it has enjoyed renewed popularity. We describe a modification of this technique which allows both transnasal endoscopic and external direct visualization of the FER and frontal sinus and a direct approach to the anterior buttress (or "nasofrontal beak") which allows its quick and simple removal.