Department of Otolaryngology-Head and Neck Surgery, Concord General Hospital, Sydney, Australia.
Int Forum Allergy Rhinol. 2011 Jul-Aug;1(4):290-5. doi: 10.1002/alr.20042. Epub 2011 Apr 14.
The modified endoscopic Lothrop (MELP) or Draf III procedure can provide extended endoscopic access to the frontal sinus. The ability to access the entire frontal sinus entirely endoscopically is often debated and there is little published data to predict access based on tumor location.
MELP was performed in 10 cadaver heads. Access was defined as the ability to contact the bone under vision with the head of a 70-degree diamond burr. Access was assessed in 3 areas: the orbital roof and the anterior and posterior walls of the frontal sinus. Endpoints were defined in millimeters from medial orbit and lateral quartile zones.
Complete lateral access was excellent anterior and posterior in 95% of sinuses (mean 15.5 ± 7.8 mm and 15.4 ± 7.7 mm, respectively). Access to the orbital roof was limited (10.3 ± 4.6 mm; p = 0.01 comparing anterior and posterior). For sinuses pneumatized beyond the midorbital point, only 10% of lateral orbital roofs were contacted. Orbital roof access correlated with the anteroposterior (AP) distance between the olfactory fossa and outer periosteum of the frontal beak (r = 0.6, p < 0.01).
Lateral endoscopic access to the walls of the frontal sinus is excellent except for the sinus floor. Access to the orbital roof is reliable in the medial quarter only and minimal lateral to the midorbital point. The ability to predict the areas accessible by the endoscopic approach and those areas that might require ancillary approaches is important for both surgical planning and patient expectations.
改良内镜洛思罗普（MELP）或 Draf III 手术可提供额窦的扩展内镜通道。能否完全经内镜进入整个额窦常常存在争议，而且很少有发表的数据可以根据肿瘤位置来预测通道。
在 10 个尸头上进行 MELP。将接触到视野下的骨质定义为可进入，使用 70 度钻石磨头。评估了 3 个区域的进入情况：眶顶和额窦的前壁和后壁。终点定义为从内侧眶和外侧四分之一区域到中线的毫米数。
95%的窦腔（分别为 15.5 ± 7.8 毫米和 15.4 ± 7.7 毫米）具有极好的完全外侧进入，包括极好的前后壁进入。眶顶的进入受限（10.3 ± 4.6 毫米；与前后壁相比，p = 0.01）。对于超过中线点的窦腔气化，只有 10%的外侧眶顶被触及。眶顶的进入与嗅束和额骨喙的骨膜前缘之间的前后（AP）距离相关（r = 0.6，p < 0.01）。
额窦壁的外侧内镜进入非常好，除了窦底。眶顶仅在内侧四分之一是可靠的，在中线外侧最小化。预测内镜入路可进入的区域和可能需要辅助入路的区域的能力对于手术计划和患者期望都很重要。
