Headache is a very common complaint of patients with many underlying causes .Headaches with sinonasal origin could have no other clinical signs and symptoms and in these cases, role of diagnostic and therapeutic endoscopy with C.Tscan are significant. Many inflammatory and anatomic lesions of the lateral nasal wall and especially middle turbinate could cause severe mucosal contact and the resulting pressure releases substance P, an impotant neuropeptide. Substance P stimulates antidromic (peripheral) and orthodromic (central) impulses; the latter impulse through C fibers reaches brain cortex and causes referal regional pain .Today with the aid of diagnostic FUNCTIONAL endoscopy and C.T scan ,the causative factors are diagnosed and then with FUNCTIONAL ENDOSCOPIC surgery the lesions are carefully removed with minimal trauma to heathy tissues, resulting in relief of headache.

Background and Objectives: FUNCTIONAL ENDOSCOPIC sinus surgery (FESS) is one of the most common procedures in the field of Otolaryngology. Most authors divide complications into ‘minor’ and ‘major’ categories. Minor complications may include bleeding, infection, synechia formation, ostial stenosis, and tooth or lip numbness, or recurrence of disease. Major complications may include hyposmia/anosmia, exposure of orbital fat, damage to extraocularmuscles, blindness, vascular damage, exposure of durra, cerebrospinal fluid (CSF) leak, intracranial injury, or death. Purpose of this study was to evaluate the complications of FUNCTIONAL ENDOSCOPIC Sinus Surgery in a group of patients with chronic sinus disease. Methods and Materials: In a prospective cross- sectional study, without control group, 62 patients who underwent FUNCTIONAL ENDOSCOPIC sinus surgery for refractory chronic sinus diseases were evaluated for Otolaryngology and Ophthalmic complications. Results: Total numbers of patients were 62 cases of chronic rhino sinusitis with poliposis (46.8%), without poliposis (32.2%) and with tumors (21%). Mean age of patients was 38.35±13.97 years (range from 15 to 75). Among this 62 patients, there were7 (11.2%) patients with ocular complications (one cellulites (1, 6%) and six patients had lids swelling and conjunctival injection). Three patients had postoperative epistaxis and one patient had Cerebrospinal fluid (CSF) leakage. We noted that 83.77% improvement in the preoperative symptoms after surgery. Conclusion: Ophthalmologic and otolaryngologic complications of FUNCTIONAL ENDOSCOPIC sinus surgery are usually minor and respond to conservative management.

Background: Meningocele is one of the rare congenital Nasal masses which can be found in newborns. Definitive treatment is surgery which may be done intracranial or extracranial, success rate for both approaches are similar. Unsuccess rate for both approaches are similar. Unsuccess rate for ENDOSCOPIC repair has been reported 0-24 percents and for intracranial repair was 6-33 percents.Results & Conclusion: Present case report of meningocele was done on an 11 years girl at Amir Alam Hospital of Tehran Medicine University in Aug, 2001 ENDOSCOPICally, which is tought to be successful. Risk of complications has been declined by. this approach compared with intracranial approach. We think that ENDOSCOPIC management of meningocele is superior to intracranial approach. We hope that our approach be accepted by our dear colleagues.

Chronic nonivasive fungal sinusitis has three forms: mycetoma, allergic fungal sinusitis and superficial sinonasal mycosis. Symptoms are usually nonspecefic with the same clinical manifestation of chronic bacterial sinusitis, allergic polypoid sinusitis and tumor like findings. ENDOSCOPIC surgery is the choice of treatment with good results. In this study 340 Pt"s with diagnosis of chronic rhinosinusitis underwent endonasal ENDOSCOPIC surgery. Based on clinical findings, staining, cultures and pathology 39 pt"s had fungal sinusitis. 21 Pt"s had allergic fungal sinustis, 11 pt"s had maxillary mycetoma, 6 cases sphenoid sinus mycetoma and one case had frontal mycetoma. Prevalance of fungal infection on our pt"s was 11.5%. All culturess were aspergillus and mean follow up time was 26 months; excent for three pt"s no recurrence was.

Background: ENDOSCOPIC sinus surgery has been used for diagnosis and treatment of chronic inflammatory diseases of paranasal sinuses since recent years. Materials and Methods: In this study 104 patients with chronic sinusitis (with or without polyps) which were managed with ENDOSCOPIC sinus surgery (ESS) were followed for 6 to 24 months after surgery (24 patients refused to continue follow up) and the recovery rate of symptoms were evaluated. Results: The effectiveness of this therapy is statistically approved and the most important symptom which diminished was nasal obstruction (from 95 percent to 18.5 percent), the least important symptom which diminished was anosmia (from 57 percent to 21 percent). Conclusion: This study confirmed the efficacy of FUNCTIONAL ENDOSCOPIC sinus surgery in improvement of chronic sinusitis symptoms.

FUNCTIONAL ENDOSCOPIC sinus surgery is a relatively new technique for the management of sinusitis refractory to noninvasive therapy. The degree of success in this surgery depends on the use of newly developed instruments and experience of the surgeon.This is a report of 114 cases that began three years ago, patients clinical and pathological data, preoperative complaints, computed tomographic ENDOSCOPIC and pathologic findings, types of surgery complications and outcome of patients are included. FESS was performed whenever symptoms persisted despite aggressive medical therapy and radiologic evidence of significant sinus abnormality; and pathologic findings and the degree of relationship between pathologic and computed tomographic findings were finally reviewed. FUNCTIONAL ENDOSCOPIC sinus surgery was popularized by Messerklinger and Stumberger who have written a number of papers on the underlying pathophysiological aspects and techniques of FESS (2, 8, 16). Patients who fail in medical management are treated with FESS. Pathologic findings in 114 of our patients undergoing ENDOSCOPIC sinus surgery who have been followed more than three years are reported here. Included in this report are 11 cases of malignancies, two of whom had not been diagnosed otherwise.

Background: An operation called FUNCTIONAL ENDOSCOPIC sinus surgery (FESS) can improve symptoms with success rates ranging from 67% to 98%. However, post-FESS management is still uncertain, and this expert opinion provides guidelines for managing patients after the surgery. Aim: This study aimed to evaluate postoperative care in FUNCTIONAL ENDOSCOPIC sinus surgery. Methods: In the current descriptive cross-sectional study, a questionnaire consisting of 25 questions about pre-and post-FESS considerations in terms of medications, imaging and the follow-up period was designed and 40 expert rhinologists in this field responded to the questions. Results: Post-operative antibiotics, pre-and post-operative corticosteroids especially in the form of nasal spray, corticosteroid-soaked Gelfoam, saline irrigation in large volumes, and nasal debridement after surgery were recommended by the majority of the surveyed experts. Post-operative imaging was suggested if any adverse event is suspected. Furthermore, oral corticosteroids are suggested for exacerbations. Most of the experts recommend long-term follow-ups. Conclusion: Based on the findings of the current survey, the experts' practice not only is remarkably variable over each other but also differs from the current guidelines. Further investigations and practical workshops are strongly recommended to improve the experts’ performance in FESS.

Background: Sinus ENDOSCOPIC surgery requires sufficient anatomical knowledge of the area. The objective of this study was to determine the variations of anatomic landmarks in patients undergoing FUNCTIONAL ENDOSCOPIC sinus surgery. Patients and Methods: This retrospective study was based on reviewing the recorded video tapes obtained during operation of 100 patients with chronic sinusitis or other sinonasal diseases who underwent ENDOSCOPIC sinus surgery. At the beginning of each operation, both nasal cavities were reviewed by 0 and 30 degrees, 4 millimeter telescope. Anatomic structures of the lateral nasal wall was viewed and findings were recorded on VHS videotapes. These videotapes were re-evaluated later. Results: The following data were obtained by reviewing these anatomic variations in 170 nasal cavities in 100 patients: Middle turbinate: typical (70%), concha bullosa (10%), sagittal cleft (4.5%), lateral displacement (5%), lateral bending (4.5%), medial bending (3%), medial displacement (3%) and transverse cleft (0%). Uncinate process: typical (82%) and medially rotated (18%). Bulla ethmoidalis: balloon shaped (typical) (60%), sausage shape (22%) and flat (18%). Accessory ostium: round (67%) and oval (33%). Sphenoid sinus ostium: oval (50%), slit (35%) and round (15%). Conclusion: This study attempted to determine the anatomic variations of the lateral nasal wall. Knowledge of these variations is important for differentiating pathologic conditions from normal anatomic variations and offers a safer and more effective ENDOSCOPIC sinus surgery with less complications.

Allergic fungal sinusitis (AFS) has been clinicopathologically defined as a noninvasive form of fungal infection. This study was designed to distinguish AFS among patients with chronic sinusitis who failed to respond to repeated courses of antibiotics and were therefore candidates for FUNCTIONAL ENDOSCOPIC sinus surgery (FESS) in Sari. Allergic mucin and sinus lavage was collected during FESS from 100 patients meeting the diagnostic criteria for AFS and were submitted for mycology and pathology investigations. The specimens were centrifuged and the sediment was mounted in 10% KOH and Gram's stain for direct examination. The specimens were inoculated in Sabouraud's Dextrose Agar. Multiple fragments of mucosa were removed at surgery and stained with H&E and PAS for the pathology evaluation. In this study we report 9 proven cases of AFS (with demonstration of fungal hyphae by direct exam and culture) and 8 suspected cases (confirmed by direct exam or culture). The patient's age ranged from 12 to 62 years, with a mean age of 24.5 years with female predominance. All of the patients were immunocompetent. 47% of the patients had a history of atopy. Histopathologically, hyphae were not seen. The genera of the fungi were identifiable in all but one patient. 53% of isolated fungi were from the hyaline hyphomycete group particularly Aspergillus and Penicillium and 47% of them were members of the dematiaceous family particularly Cladosporium and Nigrospora. In eleven out of the seventeen, fungal hyphae were noted and in all of the seventeen there were positive fungal cultures. Fungal sinusitis should be considered in all patients with chronic sinusitis that fails to repond to repeated courses of treatment. Recent advances in endoscopy and computed tomography and physician awareness will lead to improved diagnosis and treatment and will prevent multiple surgical procedures.      

Objective: ENDOSCOPIC sinus surgery is a relatively new technique for the manaement of sinusitis refractory to nonivasive therapy. Success depends on the use of newly developed instrument, including endocopes. Follow-up was carried out 143 patients who undervent FUNCTIONAL ENDOSCOPIC sinus surgery at 6 months to 30 months. Method: 143 patients, with chronic rhino-sinusitis underwent ENDOSCOPIC sinus surgery from March 2000 to May 2003. Result: Immediate postoperative data indicated 8 developed minor complications and no major complicattions. Conclusion: 143 patenits were available for long term follow up at 6 months to 30 months with success rate 95.8% for relief of chronic sinusitis.