Frontal Sinus Drillout Viable for Frontal Sinus Disease

What are the long-term results of using frontal sinus drillout (modified Lothrop procedure) to treat advanced frontal sinus disease?

Background: Persistent chronic frontal sinus disease is a challenge for surgeons to treat. The frontal sinus drillout procedure is a viable alternative for endoscopic management prior to frontal obliteration for frontal sinusitis that persists despite initial sinusotomy. It offers the advantages of decreased morbidity, improved cosmesis, and an enhanced ability to survey for recurrent disease.

Study design: Retrospective review of 204 patients who underwent frontal sinus drillout by a single surgeon at an academic medical center from June 1995 through November 2011.

Setting: Department of Otololaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston.

Synopsis: Bilateral drillout was performed in 143 cases. Surgical indications were chronic rhinosinusitis with polyps, chronic sinusitis without polyps, mucocele, and tumors. There were four intra-operative complications of cerebrospinal fluid leaks involving dural tears of 2 mm or less along the anterior ethmoid roof. Eight patients had post-operative epistaxis requiring intervention; 10 patients developed a sinus infection within one month of surgery that required additional post-operative oral antibiotics. An obstructed frontal neo-ostium was found in 16.7% of cases, and a stenosed neo-ostium in an additional 29.9%. Sixty-one patients required revision frontal sinus surgery over the 10.2-year mean follow-up period, with 37 occurring relatively rapidly. Among the frontal drillout failures, 50 patients underwent a single revision procedure, seven required two revisions, and four required three or more revisions. Ultimately, 22 patients required frontal obliteration. There were some limitations to this study: The stenosis rate on serial endoscopic examination could not be determined, there may be a practice bias that would be less likely in a multisurgeon study, and an unknown number of patients who developed recurrent frontal sinusitis may have sought surgical treatment elsewhere.

Bottom line: Frontal sinus drillout is a viable surgical approach for patients with advanced frontal sinus disease, but almost one-third of patients who undergo this procedure will ultimately require additional frontal sinus surgery.

Citation: Ting JY, Wu A, Metson R. Frontal sinus drillout (modified Lothrop procedure): long-term results in 204 patients. Laryngoscope. 2014;124:1066-1070.