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Background During dacryocystorhinostomy (DCR), the lacrimal sac wall biopsy is not routinely performed in our hospital, but it is recommended if there is a suspicion of underlying disease other than preoperatively or intraoperatively chronic inflammation. Objective Most of patients with epiphora have different causes of nasolacrimal duct obstruction (NLDO). This study aims to examine how important routine lacrimal sac biopsy is during endoscopic DCR surgery. Patients & methods The study included 50 patients with chronic unilateral epiphora. All patients underwent endoscopic DCR with NLD biopsy. Histopathologic analysis was performed for each specimen. Results The findings of NLD biopsy showed chronic inflammation in 33 cases (66%), chronic dacryocystitis in 9 cases (18%), dacryolith with dacryocystitis in one case, granuloma in 4 cases (8%), rhinoscleroma in 2 cases (4%), and one case had a neoplasm. Histopathologic findings were inflammatory cellular infiltrates in 56%, 30% and 14% in mild, moderate and severe chronic inflammatory state (CIS) score, respectively. Fibrosis in 18%, 20% and 62% in mild, moderate and severe CIS score, respectively. Capillary proliferation in 64%, 32% and 4% in mild, moderate and severe CIS score, respectively. Chronic inflammatory signs in 64%, 32% and 4% in mild, moderate and severe CIS score, respectively. Conclusion Although neoplasm and granuloma are rare cause of lacrimal sac or duct obstruction requiring DCR, they were detected through nasolacrimal assessment and routine intraoperative lacrimal sac biopsy.

Background: Craniocervical chordoma representing a challenge for surgeons. The endoscopic transoral approach is used for treatment. Additional exposure is required. However, its benefits are not sufficiently addressed. Aim: To evaluate the use of endoscopy in the transoral approach and the benefits of additional exposure in cases of craniocervical chordomas. Patients and Methods: in this study, 12 patients had a confirmed diagnosis of chordoma after histopathological examination due to the presence of craniocervical destructive lesions. The author performed all surgical cases using a microscopic transoral approach in 6 patients, an endoscopic-assisted microscopic transoral approach in 3 patients, and a purely endoscopic transoral approach in 3 patients. Eight patients required posterior cervical fusion according to the extent of instability. Preoperative and postoperative data were collected, including radiological examination and clinical status data. Results: in this study, 12 patients were evaluated clinically and radiologically. It was found that the use of endoscopic assistance in the microscopic transoral approach, or the use of the purely endoscopic transoral approach, added greater angles of exposure of the tumors that could not be reached when using a microscope alone. This led to greater tumor removal and excision with the same precautions and safety for the patient using these approaches compared with the use of the microscopic approach alone. The use of endoscopy alone minimized the incision of the posterior pharyngeal wall and led to good healing, which is an important goal in this field and additional angles of view. Conclusion:The use of endoscopy either for assistance in the microscopic transoral approach or alone led to the safe implementation and greater extent of tumor removal and excision. We recommend the use of endoscopy in such cases.

Background:In the open rhinoplasty technique, the soft tissue and ligaments are vulnerable to injury. Reconstruction of the ligaments is not performed routinely. The authors aimed to assess the effect of preservation of the nasal ligaments (ie, scroll, septocolumellar, and Pitanguy ligaments) in open-approach rhinoplasty. Methods: In this prospective cohort study, 32 patients underwent open rhinoplasty with ligament preservation after receiving precise training on five cadavers. Results: All patients had improved aesthetic and functional outcome in the early postoperative period with long-lasting preservation of tip projection and results. No patient needed secondary revision surgery for tip dropping or malrotation. The objective findings and subjective assessments were satisfying for the patients and surgeons. Conclusions: Refinements of nasal surgery have no limits. This study suggests that nasal ligament reconstruction, including of the scroll, septocolumellar, and Pitanguy ligaments, could maintain nasal tip projection and rotation for a long time.

Background: Odontogenic sinus disease requires optimal management, which includes definitive management of the underlying dental pathology. Additional endodontic management of root canal, dental extraction, or apicoectomy. So, in patients who have failed initial medical and/or dental therapy, endoscopic sinus surgery (ESS) is recommended. However, the optimal timing for ESS is still unclear in literatures. Objective: to find the optimal time for ESS in patients with odontogenic sinusitis (ODS) after the failure of the primary medical treatment. Patients and methods: This research was performed on 25 ODS patients: 14 males and 11 females. After the failure of primary medical treatment, these patients had preferred and undergone ESS. Another 21 patients who had dental intervention were used for comparison (12 females and 9 males). Assessment of the outcome was performed by the Sino-nasal Outcome Test-22 (SNOT-22) questionnaire for all patients. Results: The patients improved as there is a decrease in SNOT-22 score from 38.75 ± 9.56 to 15.7 ± 18.12 in ESS group (p =0.000), more than dental group that decreased from 37.93 ± 11.3 to 28.42 ± 21.7 (p= 0.039). It was observed that the SNOT-22 score increased as the time of intervention increased, so it is advised to start ESS as early as possible to have a successful surgery. Conclusion: An early ESS of ODS is a clue for a fast and successful treatment outcome. So, it is recommended that primary ESS is first to be performed, particularly in patients sufferings severe unresolved sinusitis, followed by dental treatment, which is the ideal protocol for management of ODS.