The endoscopic Lothrop procedure: indications and contraindications

In select patients with chronic recalcitrant frontal sinusitis, the endoscopic Lothrop procedure is increasingly being advocated as the procedure of choice prior to frontal sinus obliteration. The theoretical advantages of an endoscopic approach include less morbidity and fewer permanent complications than the osteoplastic flap procedure. Also, unlike the original external approach described by Lothrop, the bony medial orbital wall is preserved through an endoscopic approach, thereby reducing the chance of medial orbital wall collapse. Patients with recurrent stenosis due to unilateral or bilateral polyp disease, a narrow drainage pathway (ostium <5 mm), osteoneogenesis, or any combination of these conditions are likely to benefit from an extended drainage procedure such as the endoscopic Lothrop procedure. Patients with mucoceles, paranasal sinus neoplasms extending into the frontal sinus, and persistent frontal sinus disease after a fracture have also been successfully managed with this endoscopic technique. The osteoplastic flap and frontal sinus obliteration should be performed only when all other endoscopic approaches have failed, including the Lothrop procedure.