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January 30, 2025
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The Lamella Ostium Extent Mucosa (LOEM) system: a new classification and pilot study for endoscopic sinus surgery

Publicated to: EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY. - 2024-01-01 (), DOI: 10.1007/s00405-024-09092-z

Authors:

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; Lobo-Duro D; Gonzalez-Garcia J; Palacios-Garcia J; Fernandez-Liesa R; Alobid I; Bernal-Sprekelsen M
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Affiliations

Complejo Hospitalario Universitario de Santiago - Author
Complejo Hospitalario Universitario de Santiago; Universidad Internacional de Andalucía; Spanish Society of Otolaryngology and Head and Neck Surgery (SEORL-CCC) - Author
Hospital Clínic de Barcelona; Past President - Author
Hospital Clínic de Barcelona; Universidad Internacional de Andalucía; Vicepresident - Author
Hospital General Universitario de Valencia; Universidad Internacional de Andalucía - Author
Hospital Miguel Servet - Author
Hospital Universitario Fundacion Jimenez Diaz - Author
Hospital Universitario Marqués de Valdecilla; Universidad Internacional de Andalucía; Hospital Universitario Marqués de Valdecilla - Author
Hospital Universitario Ramón y Cajal; Universidad Internacional de Andalucía; Spanish Society of Otolaryngology and Head and Neck Surgery (SEORL-CCC) - Author
Hospital Universitario Virgen Macarena - Author
Hospital Universitario Virgen Macarena; Hospital Universitario Araba; Universidad Internacional de Andalucía - Author
Hospital Universitario Virgen Macarena; Universidad de Sevilla; Universidad Internacional de Andalucía - Author
Hospital Universitario Virgen Macarena; Universidad Internacional de Andalucía - Author
Hospital Universitario Virgen Macarena; Universidad Internacional de Andalucía; President - Author
Hospital Universitario Virgen Macarena; Universidad Internacional de Andalucía; Spanish Society of Otolaryngology and Head and Neck Surgery (SEORL-CCC) - Author
University Hospital of Jerez; Spanish Society of Otolaryngology and Head and Neck Surgery (SEORL-CCC) - Author
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Abstract

Purpose: This 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). Methods: LOEM 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. Results: A substantial agreement was found among the experts (κ = 0.77) in the first round, although the M item only showed fair agreement (κ = 0.37). Clarifications for this item were given in the second round, after which, the overall agreement increased to κ = 0.81 and to κ = 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%, κ = 0.82). In this study, a web-based app is provided to assist with the regular use of the LOEM system. Conclusions: The 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.
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Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2024 there are still no calculated indicators, but in 2023, it was in position 16/67, thus managing to position itself as a Q1 (Primer Cuartil), in the category Otorhinolaryngology.

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Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2026-04-04:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 10.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 10 (PlumX).

It is essential to present evidence supporting full alignment with institutional principles and guidelines on Open Science and the Conservation and Dissemination of Intellectual Heritage. A clear example of this is:

  • The work has been submitted to a journal whose editorial policy allows open Open Access publication.
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