Endoscopic lothrop surgery

Endoscopic transnasal sinus surgery is a modified Lothrop procedure in which the mids of the frontal sinus is removed, the upper part of the septum and the frontal sinus are separated to create a wide frontal sinus drainage channel with bony support. The operation preserved the lateral bone wall, so that the middle part of the channel is not easy to collapse, and the retention of the frontal sinus bone wall and the posterior wall of the nasal frontal tube ensures the smoothness of the channel. The traditional Lothrop surgery is prone to central collapse and narrow drainage channels, which makes the operation fail. Endoscopic nasal surgery has no facial scars, does not damage the forehead sensation, and can simultaneously treat the advantages of the anterior ethmoid lesions. However, the surgical area is adjacent to the horizontal plate of the ethmoid, the frontal meninges, the anterior ethmoid artery and the iliac crest. Even under endoscopic operation, the nasal frontal sinus floor is not easy to observe. Especially when the anatomical landmark is unclear, such as the middle turbinate was removed in the previous surgery, the operation is difficult. Therefore, there must be some experience in completing the operation. Treatment of diseases: chronic frontal sinusitis Indication 1. Chronic frontal sinusitis, ineffective by conservative treatment and endoscopic frontal sinustomy. 2. Frontal sinus mucus cyst. 3. Failure of nasal external sinus surgery (such as bone forming frontal sinustomy and Lynch anterior resection). 4. Frontal sinus fracture, involving nasal drainage. Preoperative preparation 1. Detailed front nose and endoscopy. 2. Coronal and horizontal CT scan of the sinus. 3. Prepare 30° and 70° endoscopes, conventional endoscopic surgical instruments, 45° or 60° suction cutter drills and cutting heads. Surgical procedure 1. Excision of the nasal mound, the upper part of the uncinate process and the anterior sieving room can be performed with a nipper and a cutting drill. 2. After the positioning of the crypt, the front of the sinus can be used to determine the position of the frontal sinus. Such as nasal foramen stenosis (<4mm), the catheter can not be inserted, or the normal anatomical landmarks in the nose are missing (the middle turbinate has been removed) difficult to locate, in order to safely perform frontal sinustomy and insertion of the catheter through the frontal sinus opening, After puncture and expansion under the eyebrow, use a micro-ring drill to drill the hole under the eyebrow and insert the flushing tube to position the frontal sinus. 3. Before the septum, the upper part of the upper septum is placed between the frontal crypts on both sides and before the nasal fore gorge. The anterior upper part of the septum was removed with a sickle knife, forward and reverse nippers, and stopped at the front of the middle turbinate. After resection, it is beneficial to enlarge the surgical field, peep into the bilateral frontal crypt and frontal sinus floor, and operate from one side and the opposite side. 4. Widening the frontal sinus floor to remove the mucosa between the bilateral crypts, and the septal margin can be an anatomical landmark. 5. Remove the frontal sinus floor and use the flushing and drilling of the flushing system to remove the bone of the frontal sinus floor along the side of the nasal foramen and expand the bone of the contralateral frontal sinus to the contralateral side. . The bones of the nasal frontal and frontal sinus should be removed as far as possible to retain a thin plate. The intranasal frontal sinus floor was opened about 10 mm × 20 mm after surgery. When the bone of the frontal sinus floor is removed, the nasal frontal tube and the posterior wall of the frontal sinus should be preserved in order to smooth the mucosal growth and prevent the stenosis. 6. Apply various surgical forceps, such as long neck forceps or ethmoid sinus pliers. Under 25° or 70° endoscopy, the frontal sinus polyps or mucous cysts can be removed under direct vision through the frontal sinus stoma. complication 1. Cerebrospinal fluid rhinorrhea. 2. Frontal sinus recurrence.