{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T17:07:55Z","timestamp":1775322475067,"version":"3.50.1"},"reference-count":19,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,4,12]],"date-time":"2022-04-12T00:00:00Z","timestamp":1649721600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004826","name":"Natural Science Foundation of Beijing Municipality","doi-asserted-by":"publisher","award":["7212090"],"award-info":[{"award-number":["7212090"]}],"id":[{"id":"10.13039\/501100004826","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The endoscopic modified Lothrop procedure (EMLP) is an important procedure used to address frontal and anterior skull-base lesions. Two techniques were established, namely, the inside-out approach and the outside-in approach. The former technique take the frontal recess and the first olfactory filament (FOF) as key landmarks while the latter use the FOF as posterior boundary. In some cases, however, these two landmarks are not available. Therefore, we supplement the outside-in approach and named it trans-nasion-complex approach (TNCA) for EMLP that can be performed without locating these two landmarks.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Two dry human skulls were used to observe the bony nasion complex. Then, five colored silicon-injected human head specimens were dissected <jats:italic>via<\/jats:italic> TNCA for EMLP. Finally, the outcomes of patients who underwent TNCA were reviewed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The nasion complex is an osseous complex that consists of the nasion and its adjacent structures, including the bilateral root of nasal bones, nasal process of frontal bones, anterior portion of the perpendicular plate of the ethmoid bone that connects with the inferior aspect of the nasal bones, and portions of the bilateral frontal process of the maxillary bones. Surgical landmarks for TNCA include the anterior superior portion of the nasal septum, anterior margin and axilla of the middle turbinate, frontal process of the maxilla bone, nasal process of the frontal bone and upper part of the nasal bone. These structures form a \u201cmushroom sign\u201d during cadaveric dissection and surgery. Twenty-one patients underwent TNCA, of whom 9 had tumors and 12 had chronic rhinosinusitis with nasal polyps (CRSwNP). None of them had major complications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>TNCA is expected to be a safe, and direct route for EMLP. Adequate understanding of the nasion complex and \u201cmushroom sign\u201d will be helpful to complete TNCA.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2022.871635","type":"journal-article","created":{"date-parts":[[2022,4,12]],"date-time":"2022-04-12T06:35:46Z","timestamp":1649745346000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Trans-Nasion-Complex Approach for Endoscopic Modified Lothrop Procedure: Conception, Anatomy, and Technique"],"prefix":"10.3389","volume":"9","author":[{"given":"Yu","family":"Zhao","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianfeng","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dazhang","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun","family":"Han","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianhui","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yibei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,4,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"276","DOI":"10.1097\/00005537-200302000-00015","article-title":"Salvage frontal sinus surgery: the endoscopic modified Lothrop procedure","volume":"113","author":"Wormald","year":"2003","journal-title":"Laryngoscope."},{"key":"B2","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1046\/j.1365-2273.2003.00692.x","article-title":"The modified endoscopic Lothrop procedure in the treatment of complicated chronic frontal sinusitis","volume":"28","author":"Wormald","year":"2003","journal-title":"Clin Otolaryngol Allied Sci."},{"key":"B3","doi-asserted-by":"publisher","first-page":"337","DOI":"10.2500\/ajra.2009.23.3328","article-title":"Frontal sinus inverted papilloma: surgical strategy based on the site of attachment","volume":"23","author":"Yoon","year":"2009","journal-title":"Am J Rhinol Allergy."},{"key":"B4","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1007\/s12105-016-0687-8","article-title":"Endonasal endoscopic surgery in the management of sinonasal and anterior skull base malignancies","volume":"10","author":"Roxbury","year":"2016","journal-title":"Head Neck Pathol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1828","DOI":"10.1002\/lary.20565","article-title":"Safety and efficacy of the endoscopic modified Lothrop procedure: a systematic review and meta-analysis","volume":"119","author":"Anderson","year":"2009","journal-title":"Laryngoscope."},{"key":"B6","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1002\/lary.24258","article-title":"Long-term outcomes for the endoscopic modified Lothrop\/Draf III procedure: a 10-year review","volume":"124","author":"Naidoo","year":"2014","journal-title":"Laryngoscope."},{"key":"B7","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1177\/194589240201600510","article-title":"Outcomes of the modified endoscopic Lothrop procedure","volume":"16","author":"Schulze","year":"2002","journal-title":"Am J Rhinol Allergy."},{"key":"B8","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1016\/S0194-5998(03)01306-8","article-title":"Endoscopic modified Lothrop procedure for the treatment of chronic frontal sinusitis: a systematic review","volume":"129","author":"Scott","year":"2003","journal-title":"Otolaryngol Head Neck Surg."},{"key":"B9","doi-asserted-by":"publisher","first-page":"952","DOI":"10.1177\/000348949410301205","article-title":"Endoscopic resection of the intranasal frontal sinus floor","volume":"103","author":"Close","year":"1994","journal-title":"Ann Otol Rhinol Laryngol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"854","DOI":"10.1001\/archotol.129.8.854","article-title":"Endoscopic frontal sinus drillout in 100 patients","volume":"129","author":"Samaha","year":"2003","journal-title":"Arch Otolaryngol Head Neck Surg."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1661","DOI":"10.1002\/lary.23319","article-title":"The outside-in approach to the modified endoscopic Lothdrop procedure","volume":"122","author":"Chin","year":"2012","journal-title":"Laryngoscope."},{"key":"B12","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1016\/S0022-3913(09)60117-7","article-title":"The relationship of facial anatomic landmarks with midlines of the face and mouth","volume":"102","author":"Bidra","year":"2009","journal-title":"J Prosthet Dent."},{"key":"B13","doi-asserted-by":"publisher","first-page":"1854","DOI":"10.1097\/SCS.0000000000002911","article-title":"Positional relationship of ethmoidal foramens with reference to the nasion and its significance in orbital surgery","volume":"27","author":"Shin","year":"2016","journal-title":"J Craniofac Surg."},{"key":"B14","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1002\/lary.27352","article-title":"Patient-reported olfaction improves following outside-in Draf III frontal sinus surgery for chronic rhinosinusitis","volume":"129","author":"Wong","year":"2019","journal-title":"Laryngoscope."},{"key":"B15","doi-asserted-by":"publisher","first-page":"242","DOI":"10.1093\/asj\/sju079","article-title":"The osseocartilaginous vault of the nose: anatomy and surgical observations","volume":"35","author":"Palhazi","year":"2015","journal-title":"Aesthetic Surg J."},{"key":"B16","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1097\/00005537-200101000-00024","article-title":"Modern concepts of frontal sinus surgery","volume":"111","author":"Weber","year":"2001","journal-title":"Laryngoscope."},{"key":"B17","doi-asserted-by":"publisher","first-page":"1039","DOI":"10.1002\/lary.25696","article-title":"First olfactory fiber as an anatomical landmark for frontal sinus surgery","volume":"126","author":"Upadhyay","year":"2016","journal-title":"Laryngoscope."},{"key":"B18","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1002\/alr.22480","article-title":"New landmarks in endonasal surgery: from nasal bone to anterior cribriform plate including branches of anterior ethmoidal artery and nerve and terminal nerve","volume":"10","author":"Roussel","year":"2020","journal-title":"Int Forum Allergy Rhinol."},{"key":"B19","doi-asserted-by":"publisher","first-page":"397","DOI":"10.2500\/ajra.2015.29.4175","article-title":"Outside-in frontal drill-out: how I do it","volume":"29","author":"Knisely","year":"2015","journal-title":"Am J Rhinol Allergy."}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2022.871635\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,4,12]],"date-time":"2022-04-12T06:35:48Z","timestamp":1649745348000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2022.871635\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,12]]},"references-count":19,"alternative-id":["10.3389\/fsurg.2022.871635"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2022.871635","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,12]]},"article-number":"871635"}}