Frontal Drillout Surgery
In some patients with severe sinus inflammation, not responsive to medical treatment or previous surgery, a frontal drillout procedure maybe required.
Endoscopic Modified Lothrop Procedure
This procedure is a more advanced procedure than standard sinus surgery. It requires specific training and is only performed by a few surgeons in South Australia. It aims to maximize the opening of the narrow frontal sinus be removing the thick bone between each frontal sinus.
In doing so a wider single frontal cavity is fashioned. This improves post-operative access for sinus irrigations and allows closer surveillance of this area. It also allows for more complete clearance of polyps and inflammation that a standard sinus procedure.
Indications for frontal drillout surgery
- Severe sinus inflammation not responsive to medications or standard sinus surgery
- Tumour resection
- Repair of brain fluid leaks
What to expect with the procedure
Frontal drillout surgery can take 3-4 hours depending on the completeness of previous sinus surgery, a patient’s anatomy and the extent of inflammatory disease. It is performed under general anaesthetic in hospital. The surgery is done entirely through the nose, with no external incisions or bruising. Using endoscopic equipment, inflamed tissue and polyps are removed and the natural openings of the sinuses widened. The thick bone separating the frontal sinuses is drilled to create a wide common frontal sinus cavity. This procedure does not weaken you nasal supports in anyway. Post-operatively dissolvable packing may be applied if deemed necessary. Non-dissolvable gauze packing is not used by Prof Psaltis due to the discomfort it causes and the protentional of causing internal scarring.
After a short period in recovery, you will be transferred to a ward. Here you will be observed for 24 hours before being discharged home. It is not uncommon to have some oozing from the nose and to feel a little obstructed initially. Following review the next morning you will be discharged home with post-operative medications. The nursing staff will show you how to preform post-operative Flo- Sinus irrigations which are essential for post-operative healing.
Despite being an extensive procedure, most patients typically do not experience too much pain from surgery. 1 out of 10 patients however can have severe pain related to the bone drilling and this can begin any time after from immediately after surgery to upto 2 weeks later. This is usually highly responsive to NSAIDs like ibuprofen. It is not uncommon to get some internal swelling of the nose that can cause nasal congestion. In some cases, patients may develop mild tissue swelling over the bridge of the nose or eyelids. This again is a reaction to the bone drilling. I recommend you irrigate your nose with FLO sinus irrigation 4x day to remove any clots and dissolve the packing material. Usually, patients require 1-2 weeks off work.
Due to the tendency for the sinuses to crust after this type of surgery, I will normally review on a 2 week basis until the sinuses have healed.