The Lamella Ostium Extent Mucosa (LOEM) system: a new classification and pilot study for endoscopic sinus surgery

Fecha de publicación: 01/02/2025 Fecha Ahead of Print: 01/12/2024

Autores de IDIVAL

David Robinson Lobo Duro

Autor

Autores ajenos al IDIVAL

Sanchez-Gomez S
Martin-Jimenez D
Moreno-Luna R
Maza-Solano J
Calvo-Henriquez C
Del Cuvillo A
Villacampa-Auba JM
Santamaria-Gadea A
Garcia-Lliberos A
Sanchez-Barrueco A
Martinez-Capoccioni G
Gonzalez-Garcia J
Palacios-Garcia J
Fernandez-Liesa R
Alobid I
Bernal-Sprekelsen M

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NANOMEDICINA

Abstract

PurposeThis study proposes the Lamella Ostium Extent Mucosa (LOEM) system as a compact and user-friendly classification for endoscopic sinus surgery (ESS), based on surgical bone extension and mucosal management, aiming to resolve inconsistencies in describing surgical techniques and extension levels, and to enhance comparability of outcomes in chronic rhinosinusitis (CRS).MethodsLOEM uses a lettering system representing a specific topographical level: L identifies the lamellae, O the ostia, E the opening of the sinus walls, and M the mucosal approach. Eleven CRS surgical cases were independently evaluated by seven rhinologists following a Delphi method in two consecutive rounds. Consensus was assessed using Cohen's kappa.ResultsA substantial agreement was found among the experts (kappa = 0.77) in the first round, although the M item only showed fair agreement (kappa = 0.37). Clarifications for this item were given in the second round, after which, the overall agreement increased to kappa = 0.81 and to kappa = 0.79 for the M item. A decrease in agreement from substantial to moderate for O and E items in the second round was found. Test-retest analysis showed an almost perfect agreement (92.96%, kappa = 0.82). In this study, a web-based app is provided to assist with the regular use of the LOEM system.ConclusionsThe LOEM system provides a compact, comprehensive code for ESS, integrating anatomical and functional aspects to represent surgical techniques described so far. This system may be suitable for facilitating communication between surgeons and collecting robust labeled data, hopefully leading to further standardization and validation of surgical approaches in future CRS studies.

Datos de la publicación

ISSN/ISSNe:: 0937-4477, 1434-4726
Tipo:: Article
Páginas:: 851-867
DOI:: 10.1007/s00405-024-09092-z
PubMed:: 39623019

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Sanchez-Gomez S:: Rhinology Unit, Department of Otolaryngology, Head and Neck Surgery, Virgen Macarena University Hospital, Dr Fedriani Av. 3, 41009, Seville, Spain

Continuing Education Master's Program in Advanced Rhinology and Anterior Skull Base, International University of Andalucía, Seville, Spain

President, Spanish Society of Otolaryngology and Head and Neck Surgery (SEORL-CCC), Madrid, Spain
Martin-Jimenez D:: Rhinology Unit, Department of Otolaryngology, Head and Neck Surgery, Virgen Macarena University Hospital, Dr Fedriani Av. 3, 41009, Seville, Spain

Department of Otolaryngology, Head and Neck Surgery, Alava University Hospital, 01009, Alava, Spain

Continuing Education Master's Program in Advanced Rhinology and Anterior Skull Base, International University of Andalucía, Seville, Spain
Moreno-Luna R:: Rhinology Unit, Department of Otolaryngology, Head and Neck Surgery, Virgen Macarena University Hospital, Dr Fedriani Av. 3, 41009, Seville, Spain

Continuing Education Master's Program in Advanced Rhinology and Anterior Skull Base, International University of Andalucía, Seville, Spain

Board Member of the Rhinology Committee, Spanish Society of Otolaryngology and Head and Neck Surgery (SEORL-CCC), Madrid, Spain
Maza-Solano J:: Rhinology Unit, Department of Otolaryngology, Head and Neck Surgery, Virgen Macarena University Hospital, Dr Fedriani Av. 3, 41009, Seville, Spain

Department of Surgery, Seville University, Seville, Spain

Continuing Education Master's Program in Advanced Rhinology and Anterior Skull Base, International University of Andalucía, Seville, Spain
Calvo-Henriquez C:: Department of Otolaryngology, Hospital Complex of Santiago de Compostela, 15706, A Coruña, Spain

Continuing Education Master's Program in Advanced Rhinology and Anterior Skull Base, International University of Andalucía, Seville, Spain

Board Member of the Rhinology Committee, Spanish Society of Otolaryngology and Head and Neck Surgery (SEORL-CCC), Madrid, Spain
Del Cuvillo A:: Rhinology and Asthma Unit, Department of Otolaryngology, Jerez University Hospital, 11407, Jerez, Spain

President of the Rhinology Committee, Spanish Society of Otolaryngology and Head and Neck Surgery (SEORL-CCC), Madrid, Spain
Villacampa-Auba JM:: ENT and Cervicofacial Surgery Department, Fundacion Jimenez Diaz University Hospital, 28040, Madrid, Spain
Santamaria-Gadea A:: Rhinology Unit and Skull Base Unit, Department of Otolaryngology, Ramón y Cajal Hospital, Madrid, Spain

Continuing Education Master's Program in Advanced Rhinology and Anterior Skull Base, International University of Andalucía, Seville, Spain

Board Member of the Rhinology Committee, Spanish Society of Otolaryngology and Head and Neck Surgery (SEORL-CCC), Madrid, Spain
Garcia-Lliberos A:: Department of Otolaryngology, Valencia University General Hospital, 46014, Valencia, Spain

Continuing Education Master's Program in Advanced Rhinology and Anterior Skull Base, International University of Andalucía, Seville, Spain
Sanchez-Barrueco A:: ENT and Cervicofacial Surgery Department, Fundacion Jimenez Diaz University Hospital, 28040, Madrid, Spain
Martinez-Capoccioni G:: Department of Otolaryngology, Hospital Complex of Santiago de Compostela, 15706, A Coruña, Spain
Lobo-Duro D:: Department of Otolaryngology, Hospital Universitario Marqués de Valdecilla, 39008, Santander, Spain

Continuing Education Master's Program in Advanced Rhinology and Anterior Skull Base, International University of Andalucía, Seville, Spain

Instituto de Investigación. Marqués de Valdecilla Research Institute (IDIVAL) and University Hospital Marqués de Valdecilla, Santander, Spain
Gonzalez-Garcia J:: Rhinology Unit, Department of Otolaryngology, Head and Neck Surgery, Virgen Macarena University Hospital, Dr Fedriani Av. 3, 41009, Seville, Spain

Continuing Education Master's Program in Advanced Rhinology and Anterior Skull Base, International University of Andalucía, Seville, Spain
Palacios-Garcia J:: Rhinology Unit, Department of Otolaryngology, Head and Neck Surgery, Virgen Macarena University Hospital, Dr Fedriani Av. 3, 41009, Seville, Spain
Fernandez-Liesa R:: Rhinology and Anterior Skull Base Unit, ENT Department, Hospital Universitario Miguel Servet, 50009, Saragossa, Spain
Alobid I:: Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic, 08036, Barcelona, Spain

Continuing Education Master's Program in Advanced Rhinology and Anterior Skull Base, International University of Andalucía, Seville, Spain

Vicepresident, Spanish Society of Otolaryngology and Head and Neck Surgery (SEORL-CCC), Madrid, Spain
Bernal-Sprekelsen M:: Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic, 08036, Barcelona, Spain

Past President, Spanish Society of Otolaryngology and Head and Neck Surgery (SEORL-CCC), Madrid, Spain

Keywords

Consensus; Nasal mucosa; Nasal surgical procedures; Paranasal sinuses; Rhinosinusitis

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