Background The 'open' (external) and 'closed' (endonasal) rhinoplasty approaches remain a subject for debate. Semiopen approach was proposed by Inchingolo and colleagues in 2012 with the advantages of the open technique without division of the columella. Patients and methods A randomized prospective single-blinded study was conducted. Thirty patients were divided into two groups. In group A, 15 patients underwent rhinoplasty with the endonasal approach, whereas in group B, 15 patients were subjected to rhinoplasty with the semiopen approach. Parameters used for evaluation were recorded intraoperatively, at 1 week, and 3 months postoperatively. Results In group B, the operative time was longer and tip accessibility was better compared with group A, with a high statistical significance. Postoperative edema was more in group B than in group A, with a significant difference in the immediate postoperative period. Conclusion The semiopen approach shows better tip accessibility compared with the ordinary closed approach, with fewer incisions compared with the tip delivery technique and with no need for columellar division as in open approach. However, it has a longer operative time with more postoperative edema compared with the closed approach. Therefore, the best use of this approach is for cases in which tip modification is needed, especially if concomitant nasal dorsum modification is also needed.

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Antrochoanal polyp (ACP) is a common unilateral benign lesion that originates from the maxillary sinus mucosa and protrudes through the choana into the nasopharynx. Patients usually present with progressive unilateral nasal obstruction. Rarely, bilateral ACPs could be encountered in clinical practice. It is important to recognize such unusual entity to spare patients unnecessary investigations and prolonged medical and aggressive surgical treatment. Generally, ACP is managed surgically with complete excision including the mucosa of origin to reduce the risk for recurrence. In this report, we present a rare case of bilateral simultaneous ACPs that was managed successfully with endoscopic excision. Review of the literature as regards the etiology, pathophysiology, different clinical presentations, and management aspects of ACP is also presented.

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Objective The aim of this study was to evaluate the relationship between the level of total serum IgE and the prognosis of allergic fungal sinusitis, possibility of recurrence and level of aggressiveness. Type of the study This study was a prospective controlled one. Patients and methods Forty patients who were diagnosed as having allergic fungal sinusitis were randomly divided into two equal groups. One group (group A) received postoperative systemic steroids, whereas the other group (group B) received postoperative local steroids only. The patients were followed up for 6 months with endoscopy and IgE level evaluation. Results The total number of patients who had recurrence of the disease 6 months postoperatively was 17. Six of them were from group A (systemic steroids) and 11 were from group B (local steroids only). Conclusion Allergic fungal sinusitis should be treated with minimal surgical or endoscopic procedures, followed by local and more important systemic steroids for a prolonged period. Patients should be followed up at close intervals postoperatively using nasal endoscopy and more importantly serum IgE (total and if available fungus specific) as it is a good indicator to the future possibility of recurrence and thus the possibility of resurgery or further medical treatment.

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Objective The objective of this study was to evaluate the effect of intranasal corticosteroid versus hypertonic saline irrigation on the nasalance scores in patients with vasomotor rhinitis (VMR). Patients and methods The study was conducted on 71 patients recruited from the Otolaryngology Department, Kasr El-Aini Hospital, Cairo University, with a history of nasal obstruction for at least 6 months, clinical and endoscopic evidence of VMR, and negative skin prick test. The patients were subjected to nasometric evaluation to obtain their nasalance scores before treatment. The patients were then randomly classified into two groups: group A, which included 33 patients who were instructed to apply mometasone furoate nasal spray two puffs in each nostril once per day for 3 months, and group B, which included 38 patients who were instructed to apply hypertonic saline nasal spray three times per day for 3 months. Patients of the two groups were re-evaluated by means of nasometry to assess the change in their nasalance scores after each treatment plan. Results The mean pretreatment nasometry score for group A was 34.55 ± 7.71, the minimum score was 18.7, and the maximum score was 48. The post-treatment nasometry score for the same group showed a mean of 46.44 ± 7.76 and ranged from a minimum of 29.9 to a maximum of 58.2. The difference between the two scores was found to be statistically significant (P = 0.014). As regards group B, the mean pretreatment nasometry score was 36.04 ± 7.36, the minimum score was 17.4, and the maximum score was 47.3. The post-treatment nasometry score for the same group showed a mean of 45.57 ± 7.4 and ranged from a minimum of 29.3 to a maximum of 55. The difference between the two scores was found to be statistically highly significant (P = 0.001). Conclusion It appears that intranasal hypertonic saline is highly effective in the treatment of VMR and approaches the effect of intranasal corticosteroids.

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In lesions affecting both anterior and posterior ethmoids where surgery is indicated, total ethmoidectomy as part of functional endoscopic sinus surgery is the state of the art. In solo posterior ethmoid lesions, there is still controversy in terms of the most direct and least destructive approach. In these cases, it is not justified to disturb the integrity of the bulla ethmoidalis and/or the middle turbinate. In this article, a novel approach to the posterior ethmoid is presented that does not disrupt the integrity of the ostiomeatal complex.

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Background The radiosensitivity of nasopharyngeal carcinoma has led to effective primary treatment using radiation with or without chemotherapy. Despite modern radiotherapy techniques, recurrent or persistent disease remains challenging. Materials and Methods This study included 10 patients who underwent endoscopic nasopharyngectomy: two primary cases of nasopharyngeal carcinoma, five cases recurrent after finishing treatment with chemoradiation by 7–14 months, and three patients showed residual disease just after finishing therapy using chemoradiotherapy confirmed with biopsy. The average age was 43.5 years. Chemoradiotherapy was performed postoperatively for all patients. Margin status and complications were evaluated. Repeated nasopharyngeal endoscopic assessment plus computed tomography and MRI imaging with contrast were carried out, with a mean follow-up period of 17.5 months. Results One patient showed recurrence (10%) and was managed with resurgery. No deaths were recorded due to the disease (overall survival rate, 100%) until the end of this study, and there were no major complications. Conclusion Endoscopic nasopharyngectomy is a feasible, direct, effective, and safe surgical procedure. Long-term follow-up is necessary for better assessment.

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Aim The aim of the present study was to evaluate the effects of middle turbinate head resection (MTR) on the outcome of endoscopic sinus surgery. Patients and methods Patients with bilateral nasal polyps were bilaterally operated upon. From one side, the polyps were removed with preservation of the head of the middle turbinate. From the other side, polyps were removed with MTR. Patients were followed up at 1, 2, 4 weeks, 6 months, 1, and 2 years postoperatively for the presence of crusts, adhesions, polyp recurrence, smell affection, frontal sinus drainage pathway obstruction, and overall nose patency. Moreover, the duration of surgery for both sides was compared. Results No statistically significant differences were observed in the presence of crusts, adhesions, polyp recurrence, smell affection, frontal sinus drainage pathway obstruction, or overall nasal patency between the findings on the two operated sides. The operative time was significantly shorter for the group with MTR. Conclusion MTR carries no adverse effects and can be carried out safely in endoscopic sinus surgery.

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Background Nasal defects are usually defined as 'partial' or 'full' thickness. The main role of reconstructive surgery is replacement of the defective tissues with nearly similar tissues. Design This study was a retrospective case series with chart review. The study was conducted at academic tertiary care medical centers. The aim of this study was to evaluate a three-layer reconstruction (functional and esthetic evaluation). Patients and methods Nine patients presented to our office with a defect in the lower third of the nose after an accident or secondary to nasal lesion removal. In our technique, we described a single-stage, three-layer reconstruction. This technique was used to repair the full thickness alar and lower lateral cartilage defects. We designed the new three-layer repair based on the normal anatomy and histology using bilobed skin flap and lateral nasal wall mucosal rotational flaps with septal cartilage graft. Results Aesthetically acceptable results were obtained without the compromise of the nasal valve function, which was assessed using acoustic rhinometry. The acoustic rhinometric evaluation for the nasal valve (1.5–2 cm from the nostril) function showed that the cross-sectional area on the repaired side was 0.46–0.78 cm² and it was 0.52–0.81 cm² on the other site (P = 0.670), with a normal nasal cycle and without compromising the airway. Moreover, minimal donor site morbidity was observed. Conclusion The bilobed skin flap and rotational mucosal flap with septal cartilage graft for full thickness alar defect, is a novel technique with minimal donor site morbidity, acceptable postoperative shape and good functional results.

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The aim of this study was to report a case of sinonasal meningioma in Sudan. Meningiomas account for nearly 20% of all intracranial neoplasms and are the second most common tumor of the central nervous system. Primary meningiomas of the nose and paranasal sinuses are extremely rare. The clinical and radiological features of these tumors are nonspecific, and consequently an accurate diagnosis requires histologic evaluation. A 62-year-old woman from North Sudan presented to our hospital in May of 2016 complaining of right nasal obstruction associated with bloody nasal secretion and proptosis. Endoscopic endonasal examination revealed a soft mass in the right nasal cavity between the septum and the middle and superior turbinates posteriorly. MRI revealed the presence of a lobulated mass with soft-part density in the right nasal cavity (middle meatus) and the right ethmoid sinus invading the orbital contents and extending intracranially. The biopsy of the lesion revealed nodular neoplasm composed of regular cells arranged in whorled pattern. One psammoma body was noted and there was no evidence of pleomorphism or necrosis. The features are consistent with sinonasal meningioma. The patient was referred to the oncological department because it was an unresectable malignant meningioma and surgery was not feasible and would create more complications. Meningiomas involving the nasal cavity and paranasal sinuses are rare. The mortality is low, and its lethality is due to the complications of the surgery and injury of vital structures. Complete surgical extirpation of sinonasal tract meningiomas has an overall good prognosis. Hence, endoscopic nasal approach is an excellent surgical option in these cases, due to its low morbidity and satisfactory lesion resection.

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Intranasal pleomorphic adenomas are quite rare and are frequently misdiagnosed . We report a nasal septal pleomorphic adenoma in a 60-year-old man. Rigid endoscopy of the nose revealed a large polypoid mass filling the right posterior nasal cavity. Computed tomography scan of the paranasal sinuses demonstrated well-pneumatized paranasal sinuses and a soft tissue mass in the posterior aspect of the right nasal cavity arising from the posterior part of the septum. A submucous resection was used as an approach to the tumor and as a method of excising the mass with the segment of septum attached to it. After 4 years, the patient had experienced no further problems with the nasal airway, and repeated nasal endoscopic examination revealed no recurrence of the disease.

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Background Persistent allergic rhinitis has significant effects on the quality of life (QOL), especially on sleep and work performance, and is associated with specific psychiatric syndromes. Aim The aim of the present study was to verify the efficacy of combined desipramine and levocetirizine in the treatment of psychological stress related to persistent allergic rhinitis, and to thereby improve the QOL of the patient. Patients and methods A total of 132 psychologically stressed persistent allergic rhinitis patients (positive Kessler Psychological Distress Scale scores ≥12) were randomly divided into two groups: the control group, which received levocetirizine, and the study group, which received levocetirizine plus desipramine. QOL for all patients was assessed by using a seven-point scale after the treatment period. Results There was a highly statistically significant better QOL in the study group (6.79) compared with the control group (2.21) (t-test=15.17 and P = 0.0001). Conclusion Desipramine and levocetirizine have a better effect on the QOL outcomes in the treatment of patients with persistent allergic rhinitis, and having psychological stress disorders. Level of evidence: 3b.

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Background and objective Middle turbinate position, bulk, and shape play a significant role in the determination of drainage and ventilation at the middle meatus. The middle turbinate constitutes the corner stone for the performance of drainage as well as ventilation functions at the area of the ostiomeatal complex. As one of the major aims of middle meatal endoscopic surgery is providing sufficient drainage and ventilation at the level of this complex, the middle turbinate should be assessed properly before the surgery with regard to its position, size, and shape, which may predispose for sinusitis through the obliteration of the ostiomeatal complex as in cases of paradoxical middle turbinate, concha bullosa of the middle turbinate, hypertrophy of the middle turbinate, and double middle turbinate. These varieties of abnormal middle turbinate need to be interfered accordingly to reduce the risk for recurrence of sinusitis after the surgery. In addition, the normal middle turbinate may lateralize postoperatively and subsequently result in the reobstruction of the drainage and ventilation at the middle meatal area. Therefore, for the purpose of maintenance of sufficient drainage and ventilation after middle meatal endoscopic surgery, it is suggested to interfere with the normal middle turbinate either by means of its partial resection at its lower part, its medialization and further fixation of it to the nasal septum with a stitch, or by creating a synechia with the mucoperiosteal flap over the nasal septum. For this reason the serial analytic coherent clinical study was planned prospectively to postulate as to which technique is the best among the previously mentioned three techniques and compared further with noninterfered middle turbinate cases. Patients and methods Sixty patients between 14 and 63 years of age with chronic sinusitis presented with clinical as well as radiological evidence of maxilloethmoidal sinusitis with or without frontal and sphenoidal involvement at ENT OPD, Al-Tarahom Private Center (Elbyda, Libya), during the period between July 2013 and March 2015 and underwent functional endoscopic sinus surgery. The patients were divided into four groups, group A (n = 16), group B (n = 18), group C (n = 6), and group D (n = 20), which included those patients who proceeded after middle meatal endoscopic surgery with the medialization of the ipsilateral middle turbinate and creation of a synechia between it and the nasal septum, partial resection of the ipsilateral middle turbinate at its lower third, medialization and further fixation of the ipsilateral middle turbinate to corresponding nasal septal flap using a vicryl stitch material, or just medialization of the ipsilateral middle turbinate without any further fixations, respectively. The four groups were compared in relation to postoperative patency persistence of the ipsilateral middle meatus and correlated with the incidence of sinusitis recurrence after the surgery. Results and conclusion An overall 49% of the patients who underwent just medialization of the ipsilateral middle turbinate without any further fixations developed recurrence of sinusitis due to reobliteration of the middle meatus either by means of a synechia between the middle turbinate and the lateral wall or by means of extreme lateralization of the middle turbinate compared with the other groups. All patients in other groups achieved complete improvement without any evidence of recurrence of sinusitis after 1 year of follow-up, apart from 12% of patients in group B who presented with evidence of sinusitis recurrence after 3–6 months postoperatively. Broadly speaking, the intervention with the normal middle turbinate can be considered as one of the important steps during the middle meatal endoscopic surgery that may help significantly toward the improvement of outcomes of this commonly performed procedure.

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Intravascular papillary endothelial hyperplasia (Masson's tumor) is a rare non-neoplastic vascular proliferative process in a normal blood vessel or vascular malformation. Nose and paranasal sinuses are extremely rare location for this type of tumor. We report a case of Masson's tumor in a 33-year-old female, presented with an obstructing nasal mass in the right side, repeated epistaxis and rhinorrhea for eight months associated with anosmia, frontal headache and proptosis.

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Aim of work The aim of the study was to evaluate the incidence of complications after prelacrimal recess approach (PLRA) and compare it with endoscopic sinus surgery for maxillary sinus lesions. Patients and methods This was a prospective study in which 20 patients were recruited between July 2013 and September 2015 from the otorhinolaryngology outpatient clinic of Kasr Al-Ainy Hospital, Cairo University. Patients with bilateral maxillary sinus lesions underwent endoscopic sinus surgery on one side and PLRA on the other side. Postoperative complications during 2-year follow-up were assessed. Results Two patients had epiphora at the PLRA side; one cured spontaneously, and the other was treated accordingly. Four patients had adhesions at the PLRA side, whereas two patients had adhesions at the middle meatal antrostomy side. Two patients developed numbness at the PLRA side, and one patient had persistent facial pain at the PLRA side. Intraoperatively there was excessive bleeding in three patients and an inferior turbinate destabilization in three patients at the PLRA side. Conclusion Our study demonstrated that, although PLRA is a minimally invasive technique, it still carries a risk for complications.

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Background Nasal airway obstruction is a common complaint faced in otorhinolaryngology, which may significantly impair the patients' quality of life. Inferior turbinate hypertrophy is one of the main causes of chronic nasal obstruction, and different surgical techniques have been described for its reduction. Aim This study compared three different inferior turbinate reduction techniques using a new objective method in addition to a subjective one. Materials and methods A randomized controlled trial was carried out on 45 patients with hypertrophied inferior turbinates, who were randomly divided into three equal groups: group A underwent partial inferior turbinectomy, group B was subjected to inferior turbinate bipolar surface cautery, and group C underwent inferior turbinoplasty. Assessment was done preoperatively and postoperatively at 2 weeks, 1 month, and 3 months using total nasal symptom score (TNSS) and endoscopic score. Results All groups had significant improvements in the TNSS and endoscopic score when compared with baseline data. TNSS mean for all groups declined from 5 to 3 at 3 months after surgery, with P values less than 0.001. Most of the cases of group A (87%), group B (60%), and group C (93%) had an endoscopic score of 0, with nasal airways greater than 6 mm at 3 months after surgery. Conclusion Partial turbinectomy, bipolar cauterization, and turbinoplasty techniques for the inferior turbinate reduction are comparable and effective regarding improvement of the obstructive as well as the nonobstructive nasal symptoms. Endoscopic score is a helpful tool for easy, rapid, and objective assessment of the nasal airway.

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Aim The aim of the study was to search for the role of correction of abnormalities of the nasal cavity in rhinogenic contact point headache and to evaluate its role in the treatment of this type of headache. Patients and methods The study included 20 patients who were recruited from September 2016 till December 2016 with rhinogenic contact headache of more than 1-year duration. Evaluation of surgical management for these cases was done as regards improvement of headache duration, intensity, and frequency over a follow-up period of 3 months at least after the operation. Results In all, 20 patients were included with ages in the range from 19 to 45 years; 11 of them were men and nine were women. Sixteen cases showed complete cure, two showed improvement, and two showed unsatisfied results. Deviated septum was found in 17 (85%) cases, concha bullosa in seven (35%) patients, and hypertrophied inferior turbinate in six (30%) patients. More than one anatomical variation was encountered in most of the cases. The two failed cases showed preoperative long duration since they started to complain of headache and longer duration of each headache attack. Conclusion Intranasal anatomical variations play a role in the pathogenesis of contact rhinogenic headache and the surgical treatment of these anatomical variations helped in improving contact headache.

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Background In spite of recent evolution of endoscopic frontal sinus surgery, some cases are still challenging due to the difficulty to reach the lateral frontal sinus even with Draf type III. This study aims to highlight the bi-portal approach to the frontal sinus disease. Materials and methods This study is a prospective study that was conducted on four patients with mean age of 56 years. Two cases were presented with allergic fungal sinusitis, one case showed an inverted papilloma and a single case of granulomatous fungal sinusitis. All patients underwent bi-portal surgery which entailed endoscopic frontal sinus surgery either Draf IIb or III plus as an external approach through the upper eyelid. Results Complete removal of the disease with no major postoperative complications, with no detection of recurrence during the 12–30-month-follow-up period. Conclusion Bi-portal frontal sinus approach is an easy noninjurious technique with very little cosmetic drawbacks allowing rhinologists to access the whole aspects of the frontal sinus, especially the lateral part.

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Introduction Endoscopic management of cerebrospinal fluid (CSF) rhinorrhea is considered by many as the ideal approach due to its low morbidity and higher closure rate. However, many challenges and controversies are still reported. Objective The aim was to discuss the challenges of endonasal repair of CSF leaks and controversies regarding the use of intrathecal fluorescein (ITF) and the number of graft layers. Materials and methods This retrospective study included 30 patients who had had endoscopic repair for their CSF rhinorrhea in our institute between July 2015 and June 2017. Fifteen (50%) patients were managed using the two-layer repair without ITF injection (group I), while the remaining were managed using three or more graft layers and ITF (group II). Results The study included 30 patients: 17 (57%) women and 13 (43%) men. Their age ranged from 4 to 68 years with mean ± SD = 38 ± 15.86 years. Eighteen cases presented with spontaneous leaks (nine of them had normal CSF pressure). Four (13.3%) cases had defects in the posterior wall of the frontal sinus while other defects involved the fovea ethmoidalis, lateral lamella, and the cribriform plate of the ethmoid. Success rate was equal in both groups (93%). Conclusion Endoscopic management of CSF rhinorrhea has many challenges including repair in the pediatric population and anatomical areas with difficult accessibility, for example, frontal sinus leaks. It requires good endoscopic visualization and endoscopic instrumentation facilities in addition to experienced surgical hands. Double-layer repair and avoidance of ITF show the same success rate as other more time-consuming strategies with life-threatening complications.

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Objective An objective smell test is essential to identify the level of smelling sensation and provide information on changes in olfaction after treatment. The aim of this study is to describe a simple, portable, inexpensive, and reliable olfaction identification test in the Arab population (Jordan smell test). Patients and methods Seven odorants that are familiar to Arab people were selected for this smell test. In academic tertiary medical center setting, odor discrimination testing in patients with sinonasal disease and in nonsmoker healthy volunteers was performed, and the results were compared with appropriate statistical formulas. Results A total of 25 healthy volunteers and another 25 age-matched and sex-matched patients with sinonasal pathology were evaluated with our smell test. Volunteers scored 13.2 in Jordan smell test, whereas the score was 9.2 in the patients (P < 0.0001). For each tested odor, there was a significant difference between both groups. Volunteers scored least for the tobacco smell, and patients scored highest for coffee. Conclusion Jordan smell test is a novel, office-based, and easy administrable method to objectively assess olfaction sensation in the Arab population. The test is flexible to changes in its different variables, such as the type or number of odors. Further studies with a larger number of participants in different Arab countries are needed to validate our results.

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Introduction Chronic sinusitis is considered one of the most important causes of olfactory dysfunction, and this is attributed to the obstructive effect of swollen mucosa and nasal polyps or inflammatory process in the olfactory mucosa. Patients and methods This study enrolled 60 patients [20 chronic rhinosinusitis with nasal polyps (CRSwp), chronic rhinosinusitis without nasal polyps (20 CRSsp), and 20 control] and used nestin antibody, a marker found in olfactory mucosa and directly related to function, to prove the etiology of olfactory dysfunction in CRS. Results It was found that nestin staining is decreased in both cases groups, but on the contrary, patients with CRSwp have more olfactory dysfunction than patients with CRSsp. This means that the inflammatory process is strongly present in both case groups; however, the presence of polyps increases olfactory function loss. Conclusion This study led to an important conclusion that both obstructive and inflammatory causes contribute to olfactory dysfunction in patients with CRS.

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Aim The purpose of this study was evaluation of static MRI in assessment of VPI and correlation to auditory perceptual assessment (APA) and nasoendoscopy. Background Velopharyngeal insufficiency (VPI) occurs owing to insufficient tissues of the velopharyngeal valve. Patients and methods This was a multidisciplinary prospective study conducted at Al-Azhar and Beni-Suef University Hospitals, Egypt. The study group consisted of 20 children with VPI postpalatoplasty, aged from 3 to 9 years. Normal MRI values were obtained from Ruotolo et al, and Perry et al. Patients were evaluated by history taking, Gutzman's and Czermark's tests, APA, nasoendoscopy, and static palatal MRI. Results APA revealed that most of the patients had bad speech scales. Nasoendoscopy revealed that most of patients had concave velum, absent posterior pharyngeal wall movement, and circular velopharyngeal gap. MRI revealed that patients' velopharyngeal parameters were significantly lower than normal values, and most of patients had symmetrical muscle limbs. Velar length and thickness had a significant positive linear correlation with degree of velar movement. Effective velar length had a moderate negative correlation with degree of velar movement and degree of open nasality. Conclusion Static MRI is an important tool in assessment of VPI but should be accompanied by dynamic tools in cases with relatively normal ranged anatomy.

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Cholesterol granulomas are benign lesions that affect many parts of the body. Although they are benign, their expansile properties might affect important neighborhood structures which is an associated risk. Paranasal sinuses are rare locations to be affected. A case of sphenoid sinus cholesterol granuloma with orbital complications is presented. The study places emphasis on preoperative examination, radiological evaluation, and endoscopic management, and we recommend including cholesterol granulomas in the differential diagnosis of cystic lesions in paranasal sinuses.

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Background Management of cerebrospinal fluid (CSF) rhinorrhea includes either conservative or surgical treatment. The aim of this study is to evaluate the results of management of CSF rhinorrhea in three tertiary care centers in Khartoum state. Patients and methods This was a prospective analysis of 40 consecutive patients who underwent management of CSF rhinorrhea between April 2016 and April 2019. Conservative management consists of a 7–30-day trial of bed rest, head elevation 15–30°, stool softeners, avoidance of straining, and diuretics. All patients were offered conservative treatment except those with meningitis and iatrogenic leak, and patients with tension pneumocephalus were managed surgically from the start. Results A total of 40 patients were included. Spontaneous CSF leak cases were 19 (47.5%), with female to male ratio of 3.75: 1. Posttraumatic CSF leak cases were 16 (40%), with male to female ratio of 2.2: 1. Five (12.5%) patients were iatrogenic, with female to male ratio of 4.0: 1; they were managed? surgically only as well as one patient with history of meningitis. Conservative treatment was successful in 11 (32%) of 34 patients. Surgical treatment was performed for 29 patients, mainly by endoscopic approach in 26 (89.7%) patients, with success rate of 96.1%; osteoplastic flap for two (6.9%) patients, with a success rate of 100%; and intracranial (frontal craniotomy) for one (3.4%) patient, with a success rate of 100%. The success rates following first surgery for patients with posttraumatic, postprocedural, and spontaneous CSF leaks were 100, 100, and 93.3%, respectively. Four patients required second surgery, which was successful in three and failed in one with persistent leak. Conclusion Patients with CSF rhinorrhea were offered conservative treatment initially, except for iatrogenic leaks and past history of meningitis. Failure of conservative management warrants surgical treatment, which has high success rates. Head trauma, technical failures, lack of CSF divergence, and poor management of spontaneous leaks were responsible for recurrence of leak. Decision for surgical repair is appropriate in a teamwork between otorhinolaryngologists and neurosurgeons with attention to surgical approach, operative details, and postoperative care.

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Objectives Isolated anterior wall frontal sinus fractures are usually managed through a coronal approach, with its potential complications such as big scar, alopecia, and paresthesia. This study evaluates the endoscopic repair of isolated anterior wall frontal sinus fractures with rigid internal fixation. Study design This was a prospective clinical trial. Setting This study was conducted at a tertiary care academic medical center. Patients and methods A total of 24 patients with isolated anterior wall frontal sinus fractures, documented with computed tomographic (CT) scans, were treated from 2010 to 2013. All were men with a mean age of 31 years (range, 21–43 years). Via a 10-mm skin incision placed in a skin crease, an endoscopic reduction by microplate fixation of the displaced bony segments was achieved. Results Three patients were excluded from the study owing to incomplete follow-up. Follow-up ranged from 13 to 29 months, with an average of 17 months. Contour deformities were perfectly restored, and cosmetic results were acceptable in all patients. Postoperative CT scans showed an excellent anatomic restoration of the frontal sinus contour in 17 patients. In four patients who had the anterior frontal sinus fractures affecting the superior orbital rime, the postoperative CT scans showed a suboptimal reduction of the bony fragments; however, they were satisfying with the forehead aesthetic contour. None of the patients complained of sinusitis or other related complications. Conclusion Isolated anterior wall frontal sinus fractures can be successfully treated endoscopically by microplate fixation. This method is a safe procedure that can be done with ease and minimal morbidity to avoid the comorbidities associated with the coronal approach. Level of evidence: The level of evidence is IIb.

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