Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA.
Department of Otolaryngology-Head and Neck Surgery, Hackensack Meridian School of Medicine at Seton Hall University, Nutley, NJ.
Int Forum Allergy Rhinol. 2020 Aug;10(8):991-995. doi: 10.1002/alr.22560. Epub 2020 May 14.
Visualization and instrumentation of the frontal sinus is not always possible with a Draf III or modified endoscopic Lothrop procedure (MELP), and external incisions can help augment exposure. We compare lateral frontal sinus access using only a MELP compared to the adjunctive transcaruncular approach and transcutaneous Lynch incision.
Twelve cadaveric heads underwent thin-cut computed tomography scanning. Measurement of the frontal beak, anteroposterior depth of the frontal sinus, and interorbital distance was performed. There were 4 specimens with poorly pneumatized frontal sinuses that were excluded from the study. Eight cadaveric heads (16 sides) were dissected and a MELP with bilateral transcaruncular and Lynch incisions for access to the lateral frontal sinus was performed. Under image guidance, measurements extended from the midline crista galli to the most lateral point of the frontal sinus visualized using a 0-degree endoscope with straight suction and a 30-degree endoscope with curved suction.
The proportion of the ipsilateral frontal sinus accessed through the contralateral nare with a 0-degree endoscope and straight suction using a MELP only, a MELP with transcaruncular approach, and a MELP with Lynch incision, respectively, averaged 41.6%, 51.6%, and 58.9% on the right, and 48.9%, 47.1%, and 61.2% on the left. Using a 30-degree endoscope and curved suction the proportion accessed using a MELP only, a MELP with transcaruncular approach, and a MELP with Lynch incision, respectively, increased to 76.1%, 62.6%, and 91.8% on the right, and 83.2%, 62.7%, and 88.7% on the left.
Adjunctive external approaches can improve access and instrumentation of the frontal sinus when combined with a MELP.
使用 Draf III 或改良内镜 Lothrop 手术（MELP）并不能始终实现额窦的可视化和器械化，而外部切口可以帮助增加暴露度。我们比较了仅使用 MELP 进行的外侧额窦入路与附加经泪囊入路和经皮 Lynch 切口的方法。
12 个头骨标本进行了薄层 CT 扫描。测量额骨喙、额窦前后深度和眶距。有 4 个标本额窦气化不良，因此被排除在研究之外。8 个头骨标本（16 侧）进行了解剖，通过 MELP 联合双侧经泪囊和 Lynch 切口进入外侧额窦。在图像引导下，使用 0 度直吸内镜和 30 度弯吸内镜从中线鸡冠到可见额窦最外侧点进行测量。
使用 0 度直吸内镜，仅通过 MELP、MELP 联合经泪囊入路和 MELP 联合 Lynch 切口，从对侧鼻腔进入同侧额窦的比例分别为右侧 41.6%、51.6%和 58.9%，左侧为 48.9%、47.1%和 61.2%。使用 30 度弯吸内镜，仅通过 MELP、MELP 联合经泪囊入路和 MELP 联合 Lynch 切口，从对侧鼻腔进入同侧额窦的比例分别增加至右侧 76.1%、62.6%和 91.8%，左侧为 83.2%、62.7%和 88.7%。
当与 MELP 联合使用时，附加的外部入路可以改善额窦的进入和器械化。
