123 results found
Saibene AM, Allevi F, Ayad T, et al., 2021, Appropriateness for SARS-CoV-2 vaccination for otolaryngologist and head and neck surgeons in case of pregnancy, breastfeeding, or childbearing potential: Yo-IFOS and CEORL-HNS joint clinical consensus statement., Eur Arch Otorhinolaryngol, Vol: 278, Pages: 4091-4099
PURPOSE: SARS-CoV-2 vaccines are a key step in fighting the pandemic. Nevertheless, their rapid development did not allow for testing among specific population subgroups such as pregnant and breastfeeding women, or elaborating specific guidelines for healthcare personnel working in high infection risk specialties, such as otolaryngology (ORL). This clinical consensus statement (CCS) aims to offer guidance for SARS-CoV-2 vaccination to this high-risk population based on the best evidence available. METHODS: A multidisciplinary international panel of 33 specialists judged statements through a two-round modified Delphi method survey. Statements were designed to encompass the following topics: risk of SARS-Cov-2 infection and use of protective equipment in ORL; SARS-Cov-2 infection and vaccines and respective risks for the mother/child dyad; and counseling for SARS-CoV-2 vaccination in pregnant, breastfeeding, or fertile healthcare workers (PBFHW). All ORL PBFHW were considered as the target audience. RESULTS: Of the 13 statements, 7 reached consensus or strong consensus, 2 reached no consensus, and 2 reached near-consensus. According to the statements with strong consensus otorhinolaryngologists-head and neck surgeons who are pregnant, breastfeeding, or with childbearing potential should have the opportunity to receive SARS-Cov-2 vaccination. Moreover, personal protective equipment (PPE) should still be used even after the vaccination. CONCLUSION: Until prospective evaluations on these topics are available, ORL-HNS must be considered a high infection risk specialty. While the use of PPE remains pivotal, ORL PBFHW should be allowed access to SARS-CoV-2 vaccination provided they receive up-to-date information.
Patel PN, Kandathil CK, Buba CM, et al., 2021, Global Practice Patterns of Dorsal Preservation Rhinoplasty., Facial Plast Surg Aesthet Med
Background: Dorsal preservation rhinoplasty (DPR) has recently received significant academic attention in part due to theoretical benefits over excisional surgical methods. The purpose of this study was to assess the global practice patterns regarding this technique. Materials and Methods: An 11-item questionnaire was electronically distributed to regional academies/societies representing rhinoplasty surgeons worldwide. Respondent exposure to and use of DPR were assessed based on geographic location. Results: Eight hundred thirty-six responses were received. Despite early publications on DPR originating largely from Western Europe and the United States, Turkey and Mexico have the greatest use of DPR techniques currently. The familiarity across many regions with preservation techniques appear to be secondary to courses and conferences rather than incorporation into training. Mexico demonstrates the greatest exposure to DPR during training. One hundred twenty-five respondents had previously used but abandoned dorsal preservation techniques. Poor results, less predictability, and complications (largely hump recurrence) are cited as common reasons for this. Conclusion: There is variability in the global practice of DPR across regions and this will likely continue to evolve.
Unadkat SN, Saleh HA, 2021, Restoring Balance and Symmetry to the Aging Nose., Facial Plast Surg, Vol: 37, Pages: 205-210
Accurate assessment of facial symmetry is a key component of successful rhinoplasty surgery but is often overlooked by both surgeon and patient. Up to three-quarters of patients with a significantly crooked nose have been found to have concurrent marked facial asymmetry. Whilst not a contraindication to rhinoplasty, provided that facial asymmetry is identified in advance and expectations realistic, the correction of nasal deformities can improve perceived facial asymmetry. In the aging face, aside from soft tissue and bony resorption that can amplify facial asymmetry, there are specific surgical challenges to the aging nose; the normal tip support mechanisms deteriorate with age giving rise to distinctive changes to the aging nose-typically tip ptosis and a hanging columella; bone quality becomes more brittle and skin overlying this area becomes thinner. There is also weakening of the external nasal valve thus causing functional impairment too. As a result, rhinoplasty techniques used in younger patients may not be suitable in the aging nose. In this article, the authors describe their experience and outline the evidence on the management of the aging patient with facial and nasal asymmetry.
Unadkat SN, Pendolino AL, Auer D, et al., 2021, The Evidence Base for the Benefits of Functional Septorhinoplasty and its Future Post COVID-19., Facial Plast Surg
Ever since the introduction of the concept of Procedures of Limited Clinical Value (PoLCV), procedures such as functional septorhinoplasty have been subject to additional funding restrictions within the British National Health Service. Recent publications have suggested that 10% of Clinical Commissioning Groups in the United Kingdom no longer fund septorhinoplasty surgery irrespective of the indications, including congenital malformations or post-trauma, and despite the strong evidence available in the literature in treating a range of health conditions. Thus, inequity exists across the country. At present functional septorhinoplasty surgery is frequently but incorrectly grouped together with aesthetic rhinoplasty, both of which are deemed to be cosmetic interventions. Moreover, as we exit the peak of the current coronavirus disease 2019 (COVID-19) pandemic, procedures deemed to be of lower clinical priority will potentially be at risk throughout Europe. The purpose of this review is twofold; the first is to put forward the evidence to commissioners in favor of functional septorhinoplasty surgery on patient well-being and mental health; the second is to demonstrate why functional septorhinoplasty surgery is a distinct procedure from aesthetic rhinoplasty and why it ought not to be classified as a procedure of limited clinical value.
Magill JC, Unadkat S, Bullock E, et al., 2021, Rhinology in the COVID-19 era: Our experience from a rhinology tertiary referral hospital and implications for future practice., Clin Otolaryngol, Vol: 46, Pages: 96-100
Javanbakht M, Saleh H, Hemami MR, et al., 2020, A Corticosteroid-Eluting Sinus Implant Following Endoscopic Sinus Surgery for Chronic Rhinosinusitis: A UK-Based Cost-Effectiveness Analysis., Pharmacoecon Open, Vol: 4, Pages: 679-686
BACKGROUND: Chronic rhinosinusitis (CRS) is one of the commonest chronic health problems among adults in the UK. Around 15% of CRS patients undergo functional endoscopic sinus surgery (FESS) annually after failing medical treatment. However, as incomplete resolution of symptoms or complications post-operatively is common, the post-operative management is considered to be as important as the surgery itself. A bioabsorbable corticosteroid-eluting sinus implant (CESI) (Propel®, mometasone furoate 370 µg) has been used as an alternative post-FESS treatment. OBJECTIVE: The objective of this study was to assess the cost effectiveness of the corticosteroid-eluting implant versus non-corticosteroid-eluting spacer following FESS for treatment of patients with CRS. METHODS: A decision tree model was developed to estimate the cost and effectiveness in each strategy. Costs and effects were estimated from a UK National Health Service (NHS) and personal social services perspective over a 6-month time horizon. Model pathways and parameters were informed by existing clinical guidelines and literature and sensitivity analyses were conducted to explore uncertainties in base-case assumptions. RESULTS: Over a 6-month time horizon, inserting CESI at the end of FESS is less costly (£4646 vs. £4655 per patient) and is the more effective intervention [total quality-adjusted life-years (QALYs) over 6 months 0.443 vs. 0.444] than non-corticosteroid-eluting spacers; hence, it is a dominant strategy. The probabilistic analysis results indicate that CESI following FESS has a 62% probability of being cost effective at the £20,000/per QALY willingness-to-pay threshold and 56% probability of being a cost-saving intervention. CONCLUSIONS: The use of CESI after FESS results in fewer post-operative complications than non-corticosteroid-eluting implants and may be a cost-saving technology over a 6-month time horizon. Although the cost of initial treatment with the
Georgalas C, Oostra A, Ahmed S, et al., 2020, International Consensus Statement: Spontaneous Cerebrospinal Fluid Rhinorrhea, INTERNATIONAL FORUM OF ALLERGY & RHINOLOGY, Vol: 11, Pages: 794-803, ISSN: 2042-6976
Unadkat SN, Andrews PJ, Bertossi D, et al., 2020, Recovery of Elective Facial Plastic Surgery in the Post-Coronavirus Disease 2019 Era: Recommendations from the European Academy of Facial Plastic Surgery Task Force., Facial Plast Surg Aesthet Med, Vol: 22, Pages: 233-237
The impact of the COVID-19 pandemic has resulted in widespread disruption to routine surgical services across the globe. As the peak of the initial pandemic passes, surgeons will increasingly resume elective work to address the backlog. Whilst urgent cases such as cancer work will be prioritized, the safe resumption of facial plastic surgery will remain an ongoing challenge; particularly if there are secondary waves of infection. Rhinoplasty and nasal reconstructive surgery in particular poses a unique challenge to address due to the due to the potential for aerosolizing the virus. A task force of facial plastic surgeons from the European Academy of Facial Plastic Surgery has collaborated to create this document detailing recommendations for resuming a safe facial plastic surgery practice. These include the need to embrace telemedicine, advice on surgical prioritization, planning of clinical area flow plans, advice on pre-/peri- and postoperative care as well as recommendations on training for residents and well-being for surgeons. The recommendations have been made in line with the best available evidence in the literature and are applicable to facial plastic surgery colleagues from around the world in order to resume a safe practice.
Bertossi D, Mohsahebi A, Philipp-Dormston WG, et al., 2020, Safety guidelines for nonsurgical facial procedures during COVID-19 outbreak., J Cosmet Dermatol, Vol: 19, Pages: 1829-1837
BACKGROUND: The novel coronavirus (COVID-19) pandemic is expected to last for an extended time, making strict safety precautions for office procedures unavoidable. The lockdown is going to be lifted in many areas, and strict guidelines detailing the infection control measures for aesthetic clinics are going to be of particular importance. METHODS: A virtual meeting was conducted with the members (n = 12) of the European Academy of Facial Plastic Surgery Focus Group to outline the safety protocol for the nonsurgical facial aesthetic procedures for aesthetic practices in order to protect the clinic staff and the patients from SARS-CoV-2 infection. The data analysis was undertaken by thematic and iterative approach. RESULTS: Consensus guidelines for nonsurgical facial aesthetic procedures based on current knowledge are provided for three levels: precautions before visiting the clinic, precautions during the clinic visit, and precautions after the clinic visit. CONCLUSIONS: Sound infection control measures are mandatory for nonsurgical aesthetic practices all around the world. These may vary from country to country, but this logical approach can be customized according to the respective country laws and guidelines.
Unadkat SN, Andrews PJ, Bertossi D, et al., 2020, Response to Whitehead et al. re: "Recovery of Elective Facial Plastic Surgery in the Post-Coronavirus Disease 2019 Era: Recommendations from the European Academy of Facial Plastic Surgery Task Force"., Facial Plast Surg Aesthet Med
Bujoreanu I, Ferguson M, Saleh H, 2020, Chemotherapy associated dural sinus thrombosis presenting as a cerebrospinal fluid leak., BMJ Case Reports, Vol: 13, Pages: 1-4, ISSN: 1757-790X
Despite the well documented increased risk of thrombosis in patients with cancer and during chemotherapy, cerebral venous sinus thrombosis (CVT) remains a rare entity. We present a rare case of cerebrospinal fluid (CSF) rhinorrhoea secondary to a left transverse sinus thrombus which occurred 2 years previously during chemotherapy for breast cancer. The patient underwent a three-layer repair using Neuro-Patch, septal cartilage and middle turbinate pedicle flap and was started on acetazolamide. There was no recurrence at 1-year follow-up. Raised intracranial pressure secondary to cerebral venous occlusion can erode the base of skull and predispose to CSF leaks. Despite the theoretical risk, there have been no cases reported where CSF leaks have occurred following chemotherapy induced CVT. We describe the first case and discuss pathophysiology and management.
Dimitrov L, Unadkat S, Khanna A, et al., 2020, ENT training amongst general practitioners: results from a questionnaire., J Laryngol Otol, Pages: 1-7
OBJECTIVES: To evaluate the level of undergraduate and post-graduate ENT exposure amongst general practitioners and their perceived quality of this training. A secondary aim was to examine whether general practitioners believe ENT department based rotations should remain in the undergraduate curriculum. METHOD: An online questionnaire-based survey was sent to general practices in England. RESULTS: A total of 417 general practitioners completed the questionnaire. Sixty-seven per cent had completed an ENT rotation at medical school whereas 27 per cent had undertaken a postgraduate placement in ENT. Fifty-one per cent had received post-graduate teaching in ENT, mainly in the form of lectures. The majority of general practitioners were not satisfied with their training in ENT at undergraduate and post-graduate levels. Eighty-five per cent of general practitioners believed formal hospital-based ENT training should remain in the undergraduate curriculum. CONCLUSION: General practitioners reported insufficient exposure to ENT during both post-graduate and undergraduate training. Proposals to outsource undergraduate ENT teaching to affiliated departments such as general practice are of concern.
Unadkat S, Pendolino AL, Joshi A, et al., 2020, A national survey of functional septorhinoplasty surgery performed in the United Kingdom: a clinician end-user questionnaire to assess current practice and help inform future practice., Eur Arch Otorhinolaryngol, Vol: 277, Pages: 475-482
PURPOSE: The aim of this national survey is to assess the current practice of functional septorhinoplasty (SRP) surgery in the UK and better inform future practice. METHODS: An ENT-UK approved questionnaire was sent out to all 135 consultant members of the British Society of Facial Plastic Surgery (BSFPS). Data was collected on numbers of functional SRPs performed on the NHS, use of outcome measures, psychology and photography support, antibiotic use, referral base and consenting practice. RESULTS: The response rate was 38.5%, with 52 out of 135 completed. The median number of annual SRP cases per surgeon was 40. Most surgeons (95%) used clinical photography as an outcome measure. However, 27% of the respondents use a subjective outcome measurement and 3% of them use an objective outcome measurement. Only 34% had access to psychology support and 60% receive their referrals from primary care. All surgeons counsel patients for aesthetic change, 15% mention CSF leak and 38% mention olfactory disturbance. The key comment from our respondents was to relabel the rhinoplasty procedure as a functional SRP procedure with the aim to remove it from the Procedures of Limited Clinical Value (PoLCV) list. CONCLUSION: The majority of our respondents perform a large proportion of the SRP surgeries in the UK with each of the respondents performing an average of 40 SRP surgeries per year. There is a need to recatergorise functional septorhinoplasty as a functional operation and recommend functional SRP surgery to be removed from the PoLCV list.
Scholfield DW, Rennie C, Saleh HA, 2020, Chronic cough and pneumonitis secondary to cerebrospinal fluid leak: Resolution after repair., Acta Otorrinolaringol Esp (Engl Ed), Vol: 71, Pages: 59-60
Varadharajan K, Choudhury N, Saleh HA, 2019, Modified Z-plasty of the internal nasal valve-To treat mechanical nasal obstruction: How we do it., Clin Otolaryngol, Vol: 44, Pages: 1203-1204
Varadharajan K, Choudhury N, Saleh HA, 2019, Septo-columelloplasty-Anchoring the caudal septum to anterior nasal spine using a hypodermic needle as a trocar., Clin Otolaryngol, Vol: 44, Pages: 211-212
Saleh HA, Beegun I, Apaydin F, 2019, Outcomes in Rhinoplasty., Facial Plast Surg, Vol: 35, Pages: 47-52
In recent years, there is an increasing trend to use health-related quality of life questionnaires after surgical procedures. The idea is to prove the success of an operation by objectively measurable parameters. Rhinoplasty is by far the most frequently performed surgery of facial plastic surgery. One of the most difficult parts of rhinoplasty is to measure the outcomes after surgery. Rhinoplasty is a unique operation because the surgeon affects three aspects: shape, function, and psychology of the patient. In an ideal world, the surgeon should have objective means of screening that cover these three aspects before and after surgery to measure outcomes. The goal of this article is to review these tools and compare them.
Hill AT, Sullivan AL, Chalmers JD, et al., 2019, British Thoracic Society Guideline for bronchiectasis in adults, THORAX, Vol: 74, Pages: 1-54, ISSN: 0040-6376
Hill AT, Sullivan AL, Chalmers JD, et al., 2018, British Thoracic Society guideline for bronchiectasis in adults, BMJ Open Respiratory Research, Vol: 5, ISSN: 2052-4439
The full British Thoracic Society Guideline for Bronchiectasis in Adults is published in Thorax. The following is a summary of the recommendations and good practice points. The sections referred to in the summary refer to the full guideline. The appendices are available in the full guideline.
Apaydin F, Stanic L, Unadkat S, et al., 2018, Postoperative Care in Aesthetic Rhinoplasty Patients., Facial Plast Surg, Vol: 34, Pages: 553-560
After rhinoplasty, during the first 24 hours, the patients should be closely monitored for pain and discomfort, nausea and vomiting, and cool compresses must be applied regularly to decrease edema and ecchymosis. In the early postoperative period of the first month, the sutures, cast, and splints are usually removed during the first week. Then the patient is followed-up at 1, 3, 6, and 12-month intervals routinely to observe healing. In the meantime, any kind of intranasal and extranasal complications should be noted. The outcome measures such as ROE, NOSE, or SCHNOS should be used 3 to 6 months after surgery. If the patient is closely followed-up, then any unwanted complication or dissatisfaction can be solved after 6 to 12 months.
Steele L, Silver B, Beegun I, et al., 2018, Cervical aortic arch: an unusual cause of a pulsatile neck mass., BMJ Case Rep, Vol: 2018
A 72-year-old man presented with epistaxis on two occasions requiring admission. Prior to performing a bilateral sphenopalatine artery ligation diathermy, anaesthetic concern was raised regarding what the patient described as a 'congenital aortic aneurysm', with an overlying scar secondary to explorative surgery as a child. The abnormality was a cervical aortic arch (CAA). CAA is a rare vascular anomaly, which most commonly manifests as a pulsatile neck mass. In this case, we discuss the differential diagnosis for a pulsatile neck mass and considerations to be made in the workup. We also highlight the importance of cardiovascular risk factor management in patients with CAA.
Choudhury N, Hariri A, Saleh H, et al., 2018, Diagnostic challenges of antrochoanal polyps: A review of sixty-one cases., Clin Otolaryngol, Vol: 43, Pages: 670-674
Ifeacho S, Magarey M, Saleh HA, 2018, Review of the management of anterior skull base leaks, Otorhinolaryngologist, Vol: 11, Pages: 5-9, ISSN: 1752-9360
Joseph J, Randhawa P, Hannan SA, et al., 2017, Body dysmorphic disorder in patients undergoing septorhinoplasty surgery: should we be performing routine screening?, Clin Otolaryngol, Vol: 42, Pages: 508-513
OBJECTIVE: Body dysmorphic disorder (BDD) is defined as having a preoccupation with a perceived flaw in one's appearance, which appears slight to others and significantly interferes with a person's functioning. When undetected in septorhinoplasty patients, it will often lead to poor outcomes. DESIGN: We performed a prospective cohort study to determine the prevalence of BDD in our patients and whether surgical correction could be considered. SETTING AND PARTICIPANTS: We recruited 34 patients being considered for septorhinoplasty in a tertiary referral rhinology clinic and a control group of 50 from the otology clinic giving a total of 84. MAIN OUTCOME MEASURES: Participants completed the Body Dysmorphic Disorder Questionnaire (BDDQ), the sino-nasal outcome test-23 (SNOT-23) and underwent nasal inspiratory peak flow (NIPF). Those found to be at high risk for BDD were referred to a clinical psychologist. RESULTS: Of the septorhinoplasty patients, 11 (32%) were high risk for BDD. Following psychological assessment, 7 (63%) patients were felt to be unsuitable for surgery and were offered psychological therapy. SNOT-23 scores were significantly higher in the BDD group indicating a negative impact on quality of life. NIPF readings were not significantly different in the BDD group compared to the control group. CONCLUSIONS: The BDDQ is a valid tool for identifying patients at risk of BDD. A close working relationship with clinical psychology has been advantageous to help the selection process of candidates for surgery when there is a high risk of BDD.
Beegun I, Saleh HA, 2017, Advocating the Use of Absorbable Sutures for Columellar Incisions Following Open Rhinoplasty., Aesthetic Plast Surg, Vol: 41
Rapidly absorbable skin sutures have been found to be of use in numerous settings including for the closure of the columellar incision following open rhinoplasty. Its removal does not routinely require trimming, and the sutures tend to fall off with minimal intervention 10-14 days postoperatively. This practice has a good acceptance by patients and utilises less resources in the follow-up period. Level of evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Doyle PW, Beegun I, Saleh HA, 2017, The Doyle-Saleh blink reflex, JOURNAL OF LARYNGOLOGY AND OTOLOGY, Vol: 131, Pages: 347-349, ISSN: 0022-2151
Nouraei SAR, Hudovsky A, Virk JS, et al., 2017, Impact of developing a multidisciplinary coded dataset standard on administrative data accuracy for septoplasty, septorhinoplasty and nasal trauma surgery., J Laryngol Otol, Vol: 131, Pages: 341-346
OBJECTIVE: This study aimed to develop a multidisciplinary coded dataset standard for nasal surgery and to assess its impact on data accuracy. METHOD: An audit of 528 patients undergoing septal and/or inferior turbinate surgery, rhinoplasty and/or septorhinoplasty, and nasal fracture surgery was undertaken. RESULTS: A total of 200 septoplasties, 109 septorhinoplasties, 57 complex septorhinoplasties and 116 nasal fractures were analysed. There were 76 (14.4 per cent) changes to the primary diagnosis. Septorhinoplasties were the most commonly amended procedures. The overall audit-related income change for nasal surgery was £8.78 per patient. Use of a multidisciplinary coded dataset standard revealed that nasal diagnoses were under-coded; a significant proportion of patients received more precise diagnoses following the audit. There was also significant under-coding of both morbidities and revision surgery. CONCLUSION: The multidisciplinary coded dataset standard approach can improve the accuracy of both data capture and information flow, and, thus, ultimately create a more reliable dataset for use outcomes and health planning.
Beegun I, Steele L, Hassaan A, et al., 2017, Outpatient clinic numbers: a review of standards and current practice., Br J Hosp Med (Lond), Vol: 78, Pages: 44-48, ISSN: 1750-8460
This article explores current recommendations for the safe and efficient running of outpatient clinics, why non-adherence exists, the consequences of non-adherence, and what can be done to improve standards. It promotes adherence to recommendations by both clinical and managerial staff.
Toma S, Saleh H, 2016, Benign Primary Neoplasms, Current Otorhinolaryngology Reports, Vol: 4, Pages: 239-248
Purpose of Review: The goal of this paper is to present a detailed up-to-date overview of sinonasal benign neoplasms by reviewing their clinical and pathological characteristics, their diagnosis and their treatment. Recent Findings: Traditionally, excision of larger benign neoplasms required invasive open approaches; however, due to advances in endoscopic surgery, there has been a shift towards their complete removal without employing any visible scars. The use of the chemotherapeutic agent 5-fluorouracil in the management of inverted papilloma in the frontal sinus has aided with disease control, where complete excision via the endoscopic route is difficult and challenging. The management of nasal papilloma by surgery, consensus opinion advocates removal of all diseased mucosa including subperiosteal excision of the sclerotic bone at the primary setting to maximize the likelihood of disease free outcome. In the management of juvenile nasopharyngeal angiofibromas, recent advances include the use of pre-surgical treatment with anti-androgen therapy which results in tumour shrinkage and devascularisation of the tumour by embolization prior to undertaking surgery. Summary: Benign sinonasal neoplasms are uncommon and have a number of aetiologies; however, they share common presenting symptoms. Despite being termed ‘benign’, some of these lesions are locally invasive involving the bone of the skull base and the orbit. An awareness of these uncommon lesions, their diagnostic characteristics and their specific management is fundamental to undertaking surgical treatment.
Choudhury N, Hariri A, Saleh H, 2016, Extended applications of the endoscopic modified Lothrop procedure., J Laryngol Otol, Vol: 130, Pages: 827-832
OBJECTIVE: The endoscopic modified Lothrop procedure is mainly used for refractory frontal sinusitis. However, we have used it as an access procedure to facilitate treatment for an extended range of additional frontal sinus pathologies. METHODS: A retrospective review of patients who underwent the endoscopic modified Lothrop procedure for 'alternative' frontal sinus pathologies was conducted. Patient data were reviewed. The main outcome parameter measured was signs of recurrence. RESULTS: Twelve patients (6 males, 6 females) from a 7-year study period, with a mean age of 45.2 years (range, 16-78 years), were analysed. The surgical indications included frontoethmoidal mucoceles, cerebrospinal fluid leaks within the frontal sinus, cystic fibrosis, frontal sinus osteoma, frontal sinus ossifying fibroma and frontal silent sinus syndrome. The mean follow-up period was 33.3 months. There were no known recurrences. CONCLUSION: We have used the endoscopic modified Lothrop procedure for a range of frontal sinus pathologies, safely and effectively, with no peri-operative complications.
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