William H. Lindsey

Modified transnasal endoscopic Lothrop procedure : further considerations

The Lothrop procedure resects the medial frontal sinus floor, superior nasal septum, and intersinus septum to create a large frontonasal communication. However, the external approach often allowed medial collapse of soft tissue and stenosis of the nasofrontal communication. We describe a modified transnasal endoscopic Lothrop procedure in which drills are used for cases in which frontal recess exploration fails to relieve obstruction of the frontal sinus. The lateral bony walls are preserved, and medial collapse does not occur. The mucosa of the posterior table and posterior nasofrontal duct is preserved, and a single common frontal opening is created. We have found this approach to be safe and reliable. Fourteen patients have undergone this procedure without complication, achieving resolution or improvement of their symptoms and maintaining wide patency of the frontonasal opening. We recognize that long‐term follow‐up will be required but remain encouraged with our favorable results to date.

Follow-up of University of Virginia experience with the modified Lothrop procedure.

Current surgical treatment of the frontal sinus disease include external approaches to obliterate or ablate the sinus and both external and transnasal methods to restore drainage into the nasal cavity. The original Lothrop procedure resects the medial frontal sinus floor, superior nasal septum, and intersinus septum, creating a large frontonasal communication. However, as described, the external approach used in this procedure often allowed medial collapse of soft tissue and the stenosis of the nasofrontal communication. This report further relates our experience with the modified transnasal endoscopic Lothrop procedure using suction drills for cases in which frontal recess exploration had failed to relieve obstruction of the frontal sinus. We present an update of the University of Virginia experience in performing the modified Lothrop procedure in 20 patients from 10/93 to 4/95. Our findings over the follow-up period (average 12 months) have verified that this procedure is effective, with a 95% patency rate for the surgically enlarged frontal sinus ostium. When compared to osteoplastic flap with fat obliteration, the modified transnasal Lothrop procedure offers the advantages of a less invasive procedure with a shorter and usually no hospitalization, less morbidity, and the increased ability to evaluate post-operatively for recurrent disease. A patient charge analysis was also performed comparing patients undergoing frontal sinus obliteration during the same time period, revealing an additional benefit of decreased patient costs for the modified transnasal Lothrop procedure. None of our patients experienced complications, and all showed significant improvement, if not complete resolution of their symptoms. Although this procedure has produced favorable results, it should be noted that this procedure is technically demanding and will require further long term follow-up to verify its efficacy and proper role in the spectrum of surgical approaches for the treatment of chronic sinusitis.

Osseous Tissue Engineering With Gene Therapy for Facial Bone Reconstruction

Objective Facial osseous defects remain a major functional and esthetic challenge for the head and neck surgeon. Tissue engineering may provide advantageous alternatives to conventional therapies. The objective of the study was to evaluate the efficacy of gene therapy in the repair of osseous facial defects.

Repair of an Osseous facial critical-size defect using augmented fibrin sealant

Objective: Osseous defects of the head and neck are a common challenge for the otolaryngologist. To develop improved reconstructive options, osteoconductive engineering experiments are being conducted. A nasal critical‐size defect (CSD) model has previously been described in which less than 7% bone healing is observed over 6 months. An implant containing fibrin sealant with and without osteoprogenitor cells is evaluated in this model.

Comparison of topical fibrin glue, fibrinogen, and thrombin in preventing seroma formation in a rat model

Fibrin glue has been shown to decrease seroma formation in animal models. To further delineate this mechanism, the efficacy of fibrin glue was compared to topical fibrinogen and thrombin in preventing postoperative seromas.

Seroma prevention using fibrin glue during modified radical neck dissection in a rat model

Seroma is a frequent sequelae of neck dissection involving cervical lymphadenectomy. The incidence is correlated with flap elevation, lymphovascular interruption, and tissue removal. Current methods of resolving seroma, such as vacuum drainage, are not risk free. A novel approach to this problem was the use of intraoperative topical fibrin glue. A model producing seromas was developed by modified radical neck dissection on Sprague-Dawley rats. Forty rats underwent this procedure. Twenty rats were treated with saline solution (control group) and 20 were treated with fibrin glue. At necropsy on day 5, a significant reduction in the frequency of seroma was noted in the fibrin glue group. Seventeen of 20 control rats had seroma whereas only 2 of 20 experimental animals had serous collection. The Fisher exact statistical correlation revealed p less than 0.000002; therefore, the use of fibrin glue in this role merits further evaluation.

Repair of nasal defects using collagen gels containing insulin‐like growth factor 1

Objective: Facial osseous defects are a common and challenging problem for the otolaryngologist—head and neck surgeon. Current methods of repair including synthetic grafts, cadaveric material, and autologous tissue have drawbacks of foreign body reactions, infectious agent transmission, and the morbidity of a second surgical site. In the effort to develop an ideal technique for osseous reconstruction, a critical‐size facial defect has previously been developed in the Sprague‐Dawley rat. This model exhibits less than 10% healing by surface area over 6 months. A novel approach to osseous reconstruction is attempted using this model with type I collagen gel augmented with insulin‐like growth factor 1 (IGF‐1). Study Design: Randomized controlled trial using a rodent model. Methods: Twelve adult male Sprague‐Dawley rats underwent a surgical procedure to produce a critical‐size nasal defect by removing the nasal bones with a cutting burr. Six animals were repaired with 300 μg of type I collagen gel. Six animals were repaired with 300 μg of type I collagen gel augmented with 3.0 μg of IGF‐1. Thirty days later, the animals were examined after necropsy. Precise planimetry, radiodensitometric analysis, and histologic sectioning were performed. Results: All animals had complete coverage of this defect with a thin layer of bone. Radiodensitometric analysis indicated that there was a statistically significant (P < .037) increase in bone density in the collagen plus IGF‐1 group compared with that of collagen only. In addition, histologic evaluation revealed increased bone density and thickness in the IGF‐1 group. Conclusion: Type I collagen gel augmented with IGF‐1 results in a significant increase in healing of a nasal critical‐size defect in a rodent model. Laryngoscope, 108:1654–1658, 1998

Repair of a rodent nasal critical-size osseous defect with osteoblast augmented collagen gel.

Objectives/Hypothesis: Facial skeletal defects are a common challenge for the otolaryngologist. Type I collagen gels have shown promise in the repair of nonhealing critical size defects (CSDs) of facial bone by providing scaffolding for new bone growth by osteoblasts at the defect perimeter. The objective of the present study was to evaluate the effect that suspending osteoblasts within a type I collagen gel has on the repair of a rodent facial CSD.

The Myospherulotic Potential of Water-Soluble Ointments

Myospherulosis is a submucosal inflammatory condition that has been linked to the use of petrolatum-based ointment in the sinus cavities of patients after paranasal sinus surgery. To avoid this problem, several investigators have suggested using water-soluble ointments. Polyethylene glycol, a vehicle commonly used for water miscible ointments, has not been examined previously with regard to its potential to cause a myospherulotic lesion. Using an in vitro model, we confirmed the potential of petrolatum ointment to produce the myospherulotic lesion and examined the myospherulotic potential of polyethylene glycol ointment.

Periosteal and galeal adhesiveness after a forehead lift in a rodent model

PURPOSE The aim of this study was to determine the strength of periosteal and galeal adhesiveness at particular intervals after subperiosteal and subperiosteal-subgaleal forehead lifting in a rodent model. MATERIALS AND METHODS Sixty mice underwent a subperiosteal or subperiosteal-subgaleal coronal forehead lift procedure. Necropic and histologic examination of the periosteal, galeal, and bone interface was performed on postoperative days 2, 4, 6, 8, and 10, and the strength of the elevated flap reattachment to underlying tissues was measured. RESULTS Tension analysis in the early postoperative period showed a higher avulsive force was required to re-elevate subgaleal-subperiosteal flaps than subperiosteal flaps. However, subperiosteal flap adhesiveness appeared to increase rapidly between postoperative days 4 and 8. By day 10, the force required to re-elevate subperiosteal flaps was significantly higher than that required for subgaleal-subperiosteal flaps (P < or = .0001). Histologic analysis showed an inflammatory response at the periosteum-bone interface, which maximized at postoperative day 6. CONCLUSIONS In the early postoperative period, subgaleal-subperiosteal flaps had higher adhesiveness than subperiosteal flaps. However, by postoperative day 10, subperiosteal forehead flaps were substantially more adherent in this rodent model.