Background: Chronic frontal sinusitis as a component of chronic rhinosinusitisis is one of the greatest challenges in rhinology. The endoscopic endonasal approach to the frontal sinus became the standard approach in chronic rhino sinusitis refractory to medical management. Objectives: The aim of this work is to assess different approaches addressing frontal sinus disease in twenty four patients with chronic frontal sinusitis resistant to medical treatment for a period not less than twelve weeks in Otorhinolaryngology Department in Zagazig University Hospitals from March 2018 to November 2018. Patients and methods: Patients' age ranged from 20 to 58 years with a mean of 32.6 ± 10.68. These patients had two different approaches on each nasal side: Zero angled endoscopic approach (to perform standard uncinectomy and anterior ethmoidectomy including resection of ethmoidal bulla with middle turbinate preservation then removal of agger nasi cells accessing frontal sinus) and resection of the superior attachment of uncinate process (with preservation of ethmoidal bulla then using 70 degree angled endoscope to expose the frontal sinus). Results: In both techniques, preservation of ethmoid artery, middle turbinate and lamina papracyae were maintained. Residual mucopurulent discharge in the frontal recess area was found in 4 sides (10%) and managed medically. Endoscopic assessment revealed lateralization of middle turbinate in 6 sides only (15 %) which had ethmoidectomy prior to frontal sinusotomy. Conclusion: Addressing frontal sinus through intact bulla technique is less invasive guarding against anterior ethmoidal artery injury, scarring at frontal recess area and frontal ostium restenosis.

Background: Patients with obstructive sleep apnea (OSA) have both anatomic and physiologic dysfunction of the upper airway during sleep resulting in repeated airway obstruction and varying degrees of hypoxemia. In patients with obstructive sleep apnea suffering from both snoring and nasal obstruction, nasal surgery relieves snoring and improves apnea/hypopnea index (AHI), lowest O2 saturation (LOS), epworth sleepness scale (ESS) and snoring severity scale (SSS) by different proportions. Objective: To compare AHI, SSS, and ESS in laser palatoplasty and combined laser palatoplasty and laser turbinoplasty. Patients and Methods: All patients underwent surgery had snoring and mild OSA symptoms, aged between 20 and 60 years with continuous positive airway pressure (CPAP) refusal, failure or non-compliance, classified according to type of surgical intervention into: group A 14 patients were treated with laser palatoplasty and laser turbinoplasty. Group B: 14 patients were treated with laser palatoplasty only. Pre and postoperative sleep study, Epworth sleepiness scale, and snoring score were reported and compared. Results: As regard AHI there was no significant difference between 2 groups at pre or post, according to ESS (epworth sleepness scale) there was no significant difference between 2 groups pre and post. Regarding SSS the preoperative snoring score was reported to be significantly more in patients who had associated nasal obstruction (group A). But after surgery, the difference in postoperative values was nonsignificant reflecting the value of performing nasal surgery in this group of patients. Conclusion: Combined nasal and palatal surgery is more effective for snoring and mild OSA than palatal surgery only.