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The sphenoid is one of the paranasal sinuses with the greatest number of anatomic variants. The complexity of the sphenoid sinus requires close clinical and radiological examination, prior to surgery, in order to prevent life-threatening complications during surgery. This paper presents the tomographic particularities of the sphenoid sinus in order to illustrate the importance of proper pre-operative preparation in endoscopic approach to sphenoidal sinus pathology.

Introduction. The primitive malignant melanoma of nasal mucosa and paranasal sinus is a rare tumor of uncertain etiology, with unpredictable biologic behavior and bad prognosis. Unlike skin melanomas, there are no risk factors and the disease is frequently manifested in older patients, whose clinical otorhinolaryngology complaints are normally non-specific and ranges from nasal obstruction to rhinorrhea and epistaxis. Unfortunately, this disease is diagnosed basically in advanced stages which makes the surgery difficult. Objective. To report a case of primitive malignant melanoma of nasal mucosa, ethmoid and frontal sinuses, that was diagnosed in 2015. It was performed a subtotal resection in another hospital in 24.08.2015, with a large local reccurence. Report. Our patient was a 78-year-old woman with bilateral nasal obstruction, light epistaxis and unilateral rhinorrhea. The ENT, CT and MRI exams showed a tumour with important, invasion of the nasal cavity structures (billateral nasal bones, left frontal process of the maxilla, the superior midpoint of the nasal septum, bilateral middle and superior turbinates, left ethmoid and bilateral frontal sinuses). The patient was submited for surgery: total macroscopic resection in the combined endoscopic approach; transnasal and modified lateral rhinotomy with titaniul plates reconstruction of the external nose architecture. Conclusions. Malignant melanomas of nasal mucosa are, in general, diagnosed in advanced stages. Their histological characteristics in the mucosa makes difficult the surgical treatment, which is one of the most efficient options, because they are resistant to chemo and radiotherapy. The early diagnosis and a good surgical treatment plan are the best option for this tumor nowadays.

In the current medical practice, nasal congestion is one of the most frequent symptoms that bring the patients at doctor. One of the most common causes of chronic nasal obstruction is inferior turbinate hypertrophy. Surgical therapy is reserved for those patients who remain symptomatic despite proper medical therapy. The authors bring into question a number of procedures and surgical techniques addressed to the inferior turbinate hypertrophy, choosing one or another depending on the surgeon’s personal experience, the existing pathology and, not at least, the patient’s wish.

Headache is a borderline pathology, faced by physicians of various specialties, which has to be thoroughly investigated to establish the etiology and appropriate treatment. The authors present a case of concha bullosa mucocele managed by endoscopic sinus surgery. The mucocele was responsible for persistent nonsystemized headache and also for the chronic rhinosinusitis of the maxillary, ethmoidal and frontal sinus because of the blockage of the middle meatus. The drainage of the anterior sinuses and the mucocele of the concha bullosa were successfully managed by endoscopic sinus surgery.

The paranasal sinus osteoma is a benign tumor characterized by a slow growth rate. Initially, the symptoms are uncharacteristic in most of the cases, afterwards they can cause headaches, nasal obstruction, epiphora etc. The authors present the case of a 45-year-old patient from IFACF - ENT “Prof. Dr. D. Hociota” with a history of frontal headache and retrobulbar pain, which started about 6 months ago. The endoscopic and computer tomographic exam mark the presence of a left frontoethmoidal tumor with bone consistency. The surgical approach was combined, with the complete macroscopic removal of the tumor and ensuring the physiological frontal sinus drainage.

Given the progress of endoscopic surgical techniques detailed knowledge of nasosinusal local anatomy is an essential clinical request for surgeons. In this paper, the aim of the authors is to illustrate the surgical endoscopic technique of sphenoidotomy and to provide a step-by-step description of the main stages of the surgical intervention.

Functional endoscopic sinus surgery gained increasing popularity among otolaryngologists in the last decades. During any endoscopic sinonasal surgery the major limiting factors are its complex anatomy and the high vascularity. Often, even a small hemorrage is sufficient to reduce visibility of the operating field. From the surgical perspective, there are novel technologies that reduce bleeding, thus, improving the visualization of the operating field. We present some methods of hemostasis used in endoscopic sinus surgery

The authors present the case of a 58-year-old female patient with a history of multiple episodes of acute dacryocistitis, treated by irrigation of the lacrimal punctum. She is admitted to our clinic for swelling of the lacrimal sac and mucopurulent discharge on applying pressure over the lacrimal sac. In spite of several irrigations, patients’ symptoms persisted and thus surgical treatment was decided. We performed a dacryocystorhinostomy with a lacrimal stent which was inserted by endonasal approach to reestablish the nasolacrimal connection. The patient didn’t require nasal packing and was discharged three days after surgery.