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Background: The endoscopic modified Lothrop procedure (EMLP) is used to manage ongoing refractory frontal sinusitis after failed previous endoscopic sinus surgery (ESS), but this approach has a significant restenosis rate. We evaluated the potential benefits of mucosal grafts and pedicled flaps on the opening of the newly formed frontal ostium. Methods: Fifty patients with refractory frontal sinusitis or mucoceles after ESS were randomized to undergo EMLP, either with (n = 27) or without (n = 23) mucosal grafts and pedicled flap reconstruction of the neo‐ostium. The frontal neo‐ostium was measured with Lindholm distending forceps, and anteroposterior (A‐P) and lateral dimensions were measured intraoperatively, and then again at 6 weeks, 6 months, and 12 months postoperatively. Olfaction outcomes were assessed using the Taiwan Smell Identification Test (TWSIT) and a smell visual analog scale (VAS) score preoperatively and at 6 months postsurgery. Results: The initial intraoperative mean lateral and A‐P dimensions were 23.2 ± 2.7 mm and 14.8 ± 2.3 mm and were significantly decreased at all time‐points postoperatively. The mucosal grafts and pedicled flaps had greater lateral and A‐P dimensions, and a greater percentage of intraoperative frontal neo‐ostium area at all time‐points postoperatively (all p < 0.05). At 6 months postoperatively, TWSIT (p = 0.027), but not the smell VAS score (p = 0.063), was significantly improved compared with baseline. TWSIT and smell VAS score changes did not differ between groups (p = 0.92 and p = 0.85, respectively). Conclusion: The use of mucosal grafts and pedicled flaps reduces stenosis of the frontal neo‐ostium postsurgery and should be considered after EMLP. [ABSTRACT FROM AUTHOR]

Background This study was undertaken to evaluate whether endoscopic sinus surgery (ESS) with a microdebrider had an impact on complication rates, and to facilitate the determination of factors associated with complications in patients who underwent ESS at a tertiary referral center in Taiwan. Methods This investigation was a retrospective study and literature review. We analyzed 997 consecutive patients who underwent ESS at Mackay Memorial Hospital in Taipei, Taiwan from January 2006 through February 2010. All data including those of patient medical information, and peri- and postoperative complications were provided by the surgeons involved in patient medical care. We analyzed the complication rates using the following 10 variables by univariate analysis and multivariate logistic regression: sex, age, Lund–Mackay score, polyp grading, previous sinonasal surgery, surgeon skill, adjunctive sinonasal surgery, mesenteric type of anterior ethmoid artery, Keros skull base type, and the use of a microdebrider. Results Of the 997 patients in our study, 78 (7.8%) had complications. Major complications occurred in five patients (0.5%): two with cerebrospinal fluid rhinorrhea, one with medial rectus muscle damage, and two with retrobulbar hematoma. Minor complications were found in 73 patients (7.3%), which included 32 patients with perioperative estimated blood loss > 15% of the total estimated blood volume, 26 with lamina papyracea damage, two with orbital cellulitis, and 13 with postoperative bleeding. Univariate analysis showed that risk factors related to complication rate were advanced Lund–Mackay scores (scores 19–24), advanced polyp grading (Grades 2 and 3), inexperienced surgeon (resident), and microdebrider usage. However, multivariate analysis revealed that complication rate was linked to advanced Lund–Mackay scores (Scores 19–24), mesenteric type of anterior ethmoid artery, and inexperienced surgeon. Conclusion Overall, the results of our study showed that the ESS complication rate was 7.8%, with risk factors including advanced Lund–Mackay scores (19–24, odds ratio 10.4) and inexperienced surgeon. It was also noted that ESS with a microdebrider had no impact on complication rates, although the presence of a mesenteric type of anterior ethmoid artery proved to be a protective factor. [ABSTRACT FROM AUTHOR]

Summary Pneumocephalus can be caused by neurosurgical procedures, endoscopic sinus surgery, craniofacial trauma, tumors of the skull base, frontal sinus cranialization, and can rarely occur spontaneously. The treatment options are conservative treatment, craniotomy, osteoplastic flap surgery of the frontal sinus, and endoscopic endonasal surgery. We herein present the case of a 61-year-old man with a frontal sinus bony defect with pneumocephalus caused by craniotomy who presented atypically with left facial cellulitis, followed by meningitis and seizures. This bony defect was successfully repaired with endoscopic modified Lothrop procedure (EMLP). At 18 months' follow-up after the surgery, neither obvious postoperative complications nor signs of pneumocephalus were noted. EMLP offered a less invasive, safer, and effective way to repair the frontal bony defect in our elderly patient. [ABSTRACT FROM AUTHOR]