Modified Lothrop Procedure -Draf III withFull House FESS - The revolutionary management for recurrent allergic nasal polyposis & fungal sinusitis:
Abstact:Modified Lothrop Procedure or Draf-lll along with a complete Sphenoethmoidectomy is the surgery of choice for recurrent allergic polyps,& Fungal sinusitis.Widely opening up all the sinuses, not only enables complete removal of the disease process, but also lets the post reach all the corners, so that the antigenic stimulation is brought down to the maximum thus drastically reducing the recurrence rate.
Allergy is an abnormally high sensitivity to certain substances, such as pollens, foods, or microorganisms. Common indicators of allergy may include sneezing,itching, skin rashes etc.
Nasal allergy leads to nasal polyposis which are abnormal growths inside the nose which can completely block the entire nasal cavity. It also blocks the olfactory area (in the roof of the nose)leading on to lack of smell, & hence taste also. It is especially dangerous to those in the kitchen since a gas leak cannot be detected.
Nasal allergy can also lead on to fungal sinusitis which could be dangerous, since it can erode the surrounding bone, & encroach the neighbouring structures such as the eye,& brain leading on to serious complications.
Medicines are there to control the allergy, but not to eradicate it.
Surgery also ( FESS-Functional Endoscopic Sinus Surgery) only can control the disease. It just removes the disease, & opens up the sinuses. But it cannot reach the lateral aspect (sides) especially of the frontal sinuses, which has been proved to be the main cause of the recurrence. Moreover the openings we make gets narrowed to nearly 30 % after 1 yr, further worsening the situation because the post operative douches ( which is a mixture of saline & local steroid) or sprays which are to be given lifelong, will not reach all corners. These douches/sprays prevent the recurrence by reducing the antigenic stimulation although the allergy may persist. But with such narrowed openings the medicines will not reach the targeted sites!
So even surgery was so far been compared to giving medicines in diabetes or hypertension. It did not eradicate the disease but only control it, & recurrence was an accepted sequelae after 4-5 years on an average.
Here in the new procedure, ( Modified Lothrop Procedure or Draf III procedure), we drill the floor of the frontal sinus, anterior to the 1st olfactory fibre behind which is the thinnest part of the skull base separating from the brain- the cribriform plate , remove1 sq cm of the nasal septum & reach out to all the corners of the frontal sinus which was not possible with the conventional endoscopic sinus surgery.
This is combined with a full house Sphenoethmoidectomy i.e opening of the Ethmoid sinuses, & Sphenoid sinuses which are situated between the eyes & behind it.
Here in this new procedure, done only in a few centres in the country, although we cannot completely eradicate the allergy, the sequelae of the allergy i.e the ployps & fungi are not only removed completely, but also the post operative life long douches will reach all the corners, since we widely open up all these sinuses ( especially the Frontal sinus up to 2cmX1.5 cms instead of the 4-5 mm in the conventional Endoscopic sinusSurgery).
So the antigenic response to the allergy is drastically brought down, leading to only around 15 % recurrence( against 100% recurrence with the conventional FESS).
This sure will revolutionise the management of the otherwise untackled condition very effectively.