Background: The most important goal in endoscopic pituitary surgery is bloodless field with better visualization under hemodynamic stability and good analgesia to improve the outcome, the current study was performed to evaluate the intraoperative anesthetic and postoperative analgesic effects of bilateral sphenopalatine ganglion block(SPGB)as adjuvant to general anesthesia in endoscopic transsphenoidal resection of pituitary adenoma. Patients and methods: Thirty patients(ASA I-II)aged 22-55 years, randomly assigned into two equal groups. After stabilization of general anesthesia, the patients received bilateral sphenopalatine ganglion block with 2ml of either2% lidocaine: 1:200000 epinephrine (SPGB group) or sterile normal saline (control group). Mean arterial blood pressure was maintained at 60-70mmHg by using nitroglycerine. Intraoperative MAP and heart rate, Nitroglycerine and propranolol consumption, blood loss, average category scale, emergence time were recorded. Also, pre and postoperative plasma B-endorphin, VAS and time of the first request for analgesia, the total dose of meperidine consumption in the first 24hours postoperatively, patient's satisfaction and postoperative complication were recorded. Results: Sphenopalatine ganglion block group showed decrease in blood loss(P<0.001), ACS(P<0.01), nitroglycerine consumption(P<0.0001)and emergence time(P< 0.001). At PACU, visual analog pain score were lower in SPGB at 0,1,6(P<0.001), there were a high difference between two groups in B-endorphin levels(P<0.001)and also in dose of meperidine, % of patients needs analgesia and patients satisfaction(P<0.002), Conclusion: Use of sphenopalatine ganglion block with general anesthesia is a safe and effective technique, it contributes in adequate intra and postoperative analgesia needed for stabilization of hemodynamics with less blood loss, improving the quality of surgical field instead of controlled hypotensive technique during endoscopic endo-nasal trans-sphenoidal hypophysectomy.

Background: Ossifying fibroma in the nasal cavity and paranasal sinus is a benign tumor histologically, however clinically may show invasive characteristics. It usually invades the orbital bone, the base of the skull and calvarium to induce orbital and cranial manifestations. It has malignancy rate of 0.4-0.5%. Aim of the study: to present two cases of Juvenile ossifying fibroma of the paranasal sinuses with orbital involvement, with special consideration to the complex surgical approaches and documenting the radiological finding and histopathological entities. Patients and Methods: This study included two female children with Juvenile ossifying fibroma of the paranasal sinuses with orbital involvement. Research has been approved by the Research Ethical Committee of otolaryngology department, faculty of medicine for girls, AL -Azhar University. Both patients subjected to complete ENT and ophthalmological examination. CT study of the paranasal sinuses, orbit and brain were done using The two patients underwent excisional biopsy of the lesions through combined trans-nasal endoscopic and orbital approaches with repair of the orbital wall with titanium as in first case and/or high-density porous polyethylene sheets as in second case . Post-operative follow up included complete ENT and ophthalmological examination and CT scan. The radiological findings and histopathogical entities of both cases were described in details. Results: Both patients similarly presented with marked Swelling and masses of the right maxillary and ethmoidal sinuses that invaded the orbit with varying degree of proptosis, dystopia and visual affection. Our patients ages were 10 and 16 years. A histopathological feature of the first case is consistent with diagnosis of trabecular variant of ossifying fibroma, while the second case is consistent with the diagnosis of psammomatoid variant of ossifying fibroma. Radilogically were partially defined expansile heterogeneous fibro-osseous mass with ground glass appearance occupying the right maxillary, ethmoidal sinuses, and the right nasal cavity and invading the orbit. No intraoperative or Post-operative complication. Conclusion: An accurate Diagnosis of JOF is made by correlation of clinical, radiological, histopathological findings. A combined Trans-Nasal endoscopic and orbital approach is effective for excision.

Background The anatomical variation of the frontal sinus and its intimate relation to the skull base and orbit makes its surgery demanding. The extended endoscopic frontal sinus surgery allows wide better drainage and preventing the recurrence of the disease. Fourteen patients underwent EEFSS from May 2017 to May 2019. These patients are nine patients presented by chronic recurrent frontal sinusitis, three patients presented by chronic recurrent fronto ethmoidal mucocele and two patients with chronic recurrent external frontal fistula. Draff III done for ten patients of them and Draff IIB done for four patients of them. This study is designed for evaluating the efficacy of the extended endoscopic frontal sinus surgery (E E F S S) in management of chronic and recurrent frontal sinus diseases. Results The neo opening of the restored frontal sinus was remained opened with Draff III with high success rate; two patients from four patients with Draff IIb were with closed nasofrontal duct. The main follow-up was 12 months; the patients were followed up post-operatively for many office visits without any other manifestations. Conclusion The chronic recurrent frontal sinus diseases can be treated successfully with extended endoscopic frontal sinus surgery (E E F S S). The extended endoscopic frontal sinus surgery (Draff III) provides good results with low morbidity and less post-operative care.

Background: Transsphenoidal approaches usually are the preferred method for treatment of pituitary tumors because of a lower risk of complications. Recently, endoscope has been introduced as an alternative and effective tool in transsphenoidal surgery.

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