{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T10:22:41Z","timestamp":1779877361383,"version":"3.53.1"},"reference-count":30,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2012,5,1]],"date-time":"2012-05-01T00:00:00Z","timestamp":1335830400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2012,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives\/Hypothesis:<\/jats:title><jats:p>Drilling in modified endoscopic Lothrop procedure (MELP) is traditionally described as commencing from the frontal recess (FR). This is challenging when the FR is involved by tumor, inflammatory disease, or scarring. The outside\u2010in MELP, where the limits of the sinusotomy are first defined and the FR is addressed last, is described.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design:<\/jats:title><jats:p>Case\u2010control study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods:<\/jats:title><jats:p>Patients undergoing MELP, using the standard or outside\u2010in approach, for inflammatory disease or endoscopic skull base surgery were assessed. Data were collected on demographics, disease characteristics, and FR involvement. Operative time was calculated from intraoperative video recording. Time points recorded were times to frontal sinus and recess connected for outside\u2010in MELP and completion of Lothrop cavity for both groups. Perioperative complications (infection, skin breach or contusion, surgical emphysema, orbital bleeding, cerebrospinal fluid leak, and intracranial complications) were recorded.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results:<\/jats:title><jats:p>Thirty patients (67% female) with a mean age \u00b1 standard deviation of 56.0 \u00b1 10.8 years underwent MELP (24 outside\u2010in, six standard). Time for Lothrop completion was shorter for outside\u2010in MELP (30.60 \u00b1 14.10 minutes vs. 69.66 \u00b1 64.52 minutes, <jats:italic>P<\/jats:italic> = .002). Among outside\u2010in MELP, mean time to frontal sinus floor discovery was 8.41 \u00b1 6.29 minutes, to recess connected 26.50 \u00b1 12.45 minutes, and were similar regardless of pathology. The time for Lothrop cavity completion was shorter for tumor cases (24.63 \u00b1 6.49 minutes) than for chronic rhinosinusitis without polyps (35.87 \u00b1 20.18 minutes) and chronic rhinosinusitis with polyps (34.62 \u00b1 11.56 minutes) (<jats:italic>P<\/jats:italic> = .05). One patient had skin edema. No other complications were recorded.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions:<\/jats:title><jats:p>The outside\u2010in MELP is technically feasible and safe. Its advantage is a wide approach to the frontal sinus with development of the Lothrop cavity en route resulting in short predictable operative times. Defining the limits of the dissection early provides a robust and efficient approach. 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