{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T18:25:04Z","timestamp":1777487104537,"version":"3.51.4"},"reference-count":15,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2018,6,8]],"date-time":"2018-06-08T00:00:00Z","timestamp":1528416000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int Forum Allergy Rhinol"],"published-print":{"date-parts":[[2018,10]]},"abstract":"Background<\/jats:title>The endoscopic modified Lothrop procedure (EMLP) is commonly performed in recalcitrant frontal sinusitis, in part to achieve better penetration of medicated irrigations postoperatively. Although EMLP requires a septectomy for exposure, it is unknown whether septectomy size affects delivery of irrigations. In this study we evaluated the role of septectomy in delivery of irrigations to the EMLP cavity.<\/jats:p><\/jats:sec>Methods<\/jats:title>EMLP was performed on fresh human cadavers with sequentially increasing septectomy (minimal septectomy: drilling across septum to combine frontal sinuses; standard septectomy: 1.5 cm anterior to middle turbinate and inferiorly to the midlevel of the turbinate; large septectomy: extension to nasal floor). Irrigation with fluorescein\u2010labeled water was performed with a 240\u2010mL irrigation bottle in the vertex position and recorded with a 30\u00b0 endoscope fixed in a 4\u2010mm trephine in the paramedian EMLP cavity. Two blinded reviewers scored irrigation distribution recordings (0 = nasal cavity only; 1 = frontal recess; 2 = medial distribution; 3 = lateral distribution; 4 = entire sinus lavage). Distribution scores were assessed with Wilcoxon rank sum analysis.<\/jats:p><\/jats:sec>Results<\/jats:title>Six specimens (mean age, 75.2 \u00b1 2.4; 50% female) were assessed. Interobserver scores were highly concordant (Kendall's W<\/jats:italic> = 0.86, p<\/jats:italic> < 0.01), internally validating the experiment. Distribution scores did not vary significantly when comparing minimal septectomy with standard or large septectomy (Z<\/jats:italic> = 0.55, p<\/jats:italic> = 0.58, Z<\/jats:italic> = 0.37, p<\/jats:italic> = 0.71).<\/jats:p><\/jats:sec>Conclusion<\/jats:title>Increasing septectomy does not improve irrigation delivery in patients undergoing EMLP. These results suggest that a limited septectomy for access to the bilateral frontal sinuses is all that is required for effective drug delivery postoperatively. This strategy may reduce morbidity associated with larger septectomies.<\/jats:p><\/jats:sec>","DOI":"10.1002\/alr.22158","type":"journal-article","created":{"date-parts":[[2018,6,8]],"date-time":"2018-06-08T13:35:10Z","timestamp":1528464910000},"page":"1127-1131","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Size of septectomy does not affect distribution of nasal irrigation after endoscopic modified Lothrop procedure"],"prefix":"10.1002","volume":"8","author":[{"given":"Christopher R.","family":"Roxbury","sequence":"first","affiliation":[{"name":"Section of Rhinology, Sinus and Skull Base Surgery Head & Neck Institute, Cleveland Clinic Foundation Cleveland OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dennis","family":"Tang","sequence":"additional","affiliation":[{"name":"Section of Rhinology, Sinus and Skull Base Surgery Head & Neck Institute, Cleveland Clinic Foundation Cleveland OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janki","family":"Shah","sequence":"additional","affiliation":[{"name":"Section of Rhinology, Sinus and Skull Base Surgery Head & Neck Institute, Cleveland Clinic Foundation Cleveland OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"McBride","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Lerner College of Medicine Cleveland OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Troy D.","family":"Woodard","sequence":"additional","affiliation":[{"name":"Section of Rhinology, Sinus and Skull Base Surgery Head & Neck Institute, Cleveland Clinic Foundation Cleveland OH"},{"name":"Department of Neurosurgery Rose Ella Burkhardt Brain Tumor and Neuro\u2013Oncology Center, Cleveland Clinic Foundation Cleveland OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raj","family":"Sindwani","sequence":"additional","affiliation":[{"name":"Section of Rhinology, Sinus and Skull Base Surgery Head & Neck Institute, Cleveland Clinic Foundation Cleveland OH"},{"name":"Department of Neurosurgery Rose Ella Burkhardt Brain Tumor and Neuro\u2013Oncology Center, Cleveland Clinic Foundation Cleveland 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