Hemangiomas of the nasal cavity are extremely rare in the practice of an otorhinolaryngologist and can be presented in various histopathological variants. Scientific data on hemangiomas of the sinonasal region are analyzed and systematized. The article describes the principles of diagnosis and choice of the method of surgical treatment of hemangiomas. An analysis of the literature data shows that with hemangiomas of the nasal cavity, a comprehensive examination of the patient is required, including collection of complaints and anamnesis, endoscopy of the nasal cavity and computed tomography of the paranasal sinuses, and with significant hemangiomas spreading to neighboring anatomical areas, magnetic resonance imaging with intravenous contrast.

Intraosseous vascular pathology of the turbinates is extremely rare in the practice of an otorhinolaryngologist and can be presented in various histopathological variants. The article presents two clinical cases in which an intraosseous cavernous hemangioma was hidden under the mask of a hypertrophied middle turbinate. The final diagnosis was established by the results of histological examination. The analysis of these clinical cases indicates that, despite the low prevalence, atypical clinical and CT picture, intraosseous formations of the nasal cavity can be of a vascular nature and certainly require a comprehensive examination, including CT, CT with contrast and/or MRI of the nose and paranasal sinuses. These clinical observations indicate that preliminary embolization of feeding vessels before surgical treatment is not required.

Treatment of patients with severe chronic and recurrent forms of sinusitis, complicated by pathological stretching of the paranasal sinuses, is not a trivial task. This is especially true for those clinical cases where a pathological increase in the size of the sinus leads to widespread destruction of its walls and may be accompanied by serious complications from adjacent structures. The paper presents an analytical review of publications on the topic of pathological stretching of the paranasal sinuses. Potential factors influencing the development of this pathology, mechanisms of pathogenesis and classification options are described in detail. Modern approaches are considered in the surgical treatment of this pathology, which can be carried out in one or two stages, depending on the presence of secondary aesthetic defects.

Surgical treatment of inflammatory diseases of the frontal sinus is one of the biggest challenges of modern otorhinolaryngology. Close proximity of the frontal sinus and frontal sinus drainage pathways to the skull base, the orbit and the anterior ethmoid artery, great limitations with its visualization and instrumentation, and high risk of the frontal recess scarring cause difficulties in either endoscopic or external approaches to the frontal sinus. At the same time endoscopic approach to the frontal sinus is considered as preferred method of frontal sinusitis surgical treatment by majority of peers nowadays. The introduction of extended approaches to the frontal sinus pathology treatment with frontal sinus floor and interfrontal sinus septum drill-out as well as superior septectomy with common drainage pathway formation gave an opportunity to greatly decrease a rate of indications for external frontal sinus procedures. In this paper historical backgrounds of endonasal approaches to frontal sinuses are presented, current controversies in proper selection of extent and methods of the frontal sinus surgery are analyzed and endoscopic as well as external approaches to frontal sinuses are summarized.

Surgical treatment of inflammatory diseases of the frontal sinus is one of the biggest challenges of modern otorhinolaryngology. Close proximity of the frontal sinus and frontal sinus drainage pathways to the skull base, the orbit and the anterior ethmoid artery, great limitations with its visualization and instrumentation, and high risk of the frontal recess scarring cause difficulties in either endoscopic or external approaches to the frontal sinus. At the same time endoscopic approach to the frontal sinus is considered as preferred method of frontal sinusitis surgical treatment by majority of peers nowadays. The introduction of extended approaches to the frontal sinus pathology treatment with frontal sinus floor and interfrontal sinus septum drill-out as well as superior septectomy with common drainage pathway formation gave an opportunity to greatly decrease a rate of indications for external frontal sinus procedures. In this paper historical backgrounds of endonasal approaches to frontal sinuses are presented, current controversies in proper selection of extent and methods of the frontal sinus surgery are analyzed and endoscopic as well as external approaches to frontal sinuses are summarized.

Treatment of chronic rhinosinusitis (CRS), especially polypoid, represents a great medical challenge as there are still no reliable methods providing satisfactory long-term outcomes. Besides promising results of newly developed medical treatments, new algorithms for phenotype-specific treatment are to be established by medical society. Poorly understood mechanisms of CRS development, multifactorial nature of the disease, and the tendency of CRS to form “difficult-to-treat” inflammation types contribute to the treatment complexity, with surgical methods still playing a crucial role. Endoscopic sinus surgery is accepted worldwide as a gold standard of surgical treatment of different CRS forms but approaches and surgical techniques differ greatly among specialists: some follow minimally invasive techniques, others perform classic functional methods, while a group of surgeons tends to carry out extended operations with maximal resection of anatomical structures in order to create a single cavity. Additionally, great difference exists in surgical techniques, surgical instruments to be used, opinions on whether uncinate process should be removed or not for maxillary sinus approach, what size of sinus ostium is optimal and which approach to frontal sinus is more appropriate. One of the most challenging problems in rhinology is refractory forms of frontal sinusitis, in which various methods of surgical treatment frequently fail. Moreover, every new surgery frequently makes next treatment more difficult, making the decision-making process on a more appropriate approach especially hard. One of the novel promising methods of surgical treatment of severe frontal sinusitis is endoscopic extended frontal sinus drill-out procedure (Draf 3). There is increasing evidence that this kind of surgery gives reliable long-term results. However, this method has several limitations including technical issues, need for an image guidance and a high qualification of the endoscopic sinus surgeon. Alternative to this technique is open frontal sinus surgery with sinus cavity obliteration, however, it also still carries a number of limitations. This literature review describes recent opinions on different aspects of chronic rhinosinusitis including basic trends and concepts of surgical treatment, their benefits and limitations, and associated problems and controversies. Лечение хронического риносинусита (ХРС), особенно сопровождающегося ростом полипов, представляет собой сложную медицинскую проблему, поскольку ни один из существующих методов не дает надежных и долгосрочных результатов. Несмотря на многообещающие результаты лечения ХРС новыми препаратами, научному сообществу еще предстоит определить алгоритм ведения пациентов в зависимости от фенотипа заболевания. Кроме этого недостаточно изученные механизмы развития заболевания, его многофакторность и формирование устойчивых форм синуситов осложняет его лечение, где сущест- венную роль продолжает играть хирургическое вмешательство. Несмотря на всеобщее признание эн- доскопической риносинусохирургии как золотого стандарта хирургического лечения ХРС, применяемые при вмешательствах техники и подходы различаются: одни специалисты придерживаются минимально инвазивных методов, другие – принципов классической функциональной риносинусохирургии, третьи пропагандируют необходимость максимального удаления анатомических структур с формированием единой полости. Кроме этого различаются подходы к технике вмешательств, использование инструмен- тов, мнения относительно необходимости сохранения или удаления крючковидного отростка при доступе в верхнечелюстную пазуху, степени расширения соустий околоносовых пазух, а также методов и объемов вмешательства на лобных пазухах. Наибольшую сложность для лечения представляют устойчивые формы хронического фронтального синусита, поскольку используемые методы хирургического лечения зачастую не позволяют справиться с проблемой. Более того, каждое новое вмешательство зачастую осложняет последующее лечение, особенно процесс принятия решения о выборе наиболее верного подхода. Одним из последних многообещающих способов хирургического лечения сложных форм фронтального синусита является эндоскопическая расширенная хирургия с высверливанием дна лобных пазух (Draf 3). Иссле- дования показывают более прогнозируемые и стабильные результаты этой операции, однако она имеет ряд ограничений, связанных с техническими сложностями, необходимостью использования интраопера- ционной навигационной системы и большого эндоскопического опыта у хирурга. Альтернативой этому методу служит наружная остеопластическая фронтотомия с облитерацией полости пазухи, которая также имеет свои преимущества и недостатки. В представленном литературном обзоре описаны современные представления о хирургическом лечении ХРС, основные направления и подходы, применяемые в хирургии околоносовых пазух, их сильные и слабые стороны, а также связанные с ними проблемы и противоречия.

Features of the location of the sphenoid sinus determine the possibility of developing severe intraoperative complications in the surgical treatment of patients with chronic sphenoiditis. Technical difficulties during sphenoidotomy may arise at the initial stage of expansion of the natural anastomosis with its anatomical narrowness and the impossibility of inserting biting forceps.PURPOSE OF THE STUDY:To study the clinical efficacy and safety of the proposed original method of dilatation of the sphenoid sinus fistula in the surgical treatment of various forms of chronic sphenoiditis.MATERIAL AND METHODS:The study included 68 patients of both sexes older than 18 years with chronic sphenoiditis, who are indicated for surgery on the sphenoid sinus. Patients of the 1st group (n=36) underwent expansion of the fistula of the sphenoid sinus using the traditional method. Patients of the 2nd group (n=32) underwent dilatation of the anastomosis of the sphenoid sinus using the tool developed by us. Intraoperatively, the quality of visualization of the surgical field, the time of the operation, and the presence of complications were assessed. In the postoperative period, the number of complications, relapses of the disease and the condition of the sinus were recorded according to the results of computed tomography 3-4 months after the operation.RESULTS:The use of the method of dilated expansion of the anastomosis of the sphenoid sinus using special forceps developed by us helps to reduce the duration of the operation, improve intraoperative visualization of the sphenoid sinus and improve the results of treatment according to endoscopy and control computed tomography. When using the developed tool, the number of episodes of intraoperative bleeding that hindered visualization and necessitated coagulation was lower than when using an alternative technique.CONCLUSION:The technique of endoscopic dilatation of the anastomosis of the sphenoid sinus using the developed tool can be used both independently and as a preliminary step for expanding the anastomosis of the sphenoid sinus, followed by the use of a shaver or Kerrison forceps.

В статье представлен аналитический обзор публикаций, касающихся течения новой коронавирусной инфекции (COVID-19) у пациентов с полипозным синуситом. Приведены современные данные о влиянии полипозного синусита на течение COVID-19. Подробно описаны потенциальные факторы, влияющие на риск заражения SARS-CoV-2 и течение COVID-19 при разных фенотипах/эндотипах синоназального воспаления.

Treatment of patients with severe chronic and recurrent forms of frontal sinusitis, often caused by scarring as a result of repeated interventions in the frontal sinuses, is a difficult task. In such cases, for adequate drainage of the frontal sinus and ensuring stable patency of the nasolabial anastomosis, an endoscopic extended frontotomy can be the choice operation, the possibility of which certainly depends on the experience of the surgeon, anatomical features of the structure of the frontal sinus and the nature of the pathological process. The article shows the effectiveness of surgical treatment of chronic purulent frontal sinusitis that developed after 5 interventions on the paranasal sinuses with external and combined access, accompanied by the development of a fistulous passage of the anterior wall of the frontal sinus. For wide drainage of the frontal sinus and stable preservation of patency of the nasolabial fistula, the patient underwent extended endoscopic frontotomy (Draf III operation according to the international classification).

Isolated sphenoid osteomas are very rare even in adults. There are extremely few publications on pediatric cases of sphenoid osteomas. This paper presents a case of isolated sphenoid osteoma combined with suppurative sphenoiditis in a 15-year-old patient. The child presented with persistent headache resistant to medical treatment. Endoscopic sphenotomy allowed both to remove osteoma and to relieve the symptoms of sinusitis. The presented case can be considered as the third detailed description of the sphenoid osteoma in children and the first demonstration of the effectiveness of the endoscopic approach for its removal.

Chronic rhinosinusitis (CRS), functional respiratory disorders and disturbance of the external nose appearance are common problems for the surgeon. Due to the development of new technologies, including endoscopic sinus surgery (FESS) and preservation rhinoplasty (PR), the question of the safety and effectiveness of combined surgery is rising. A systematic review of the literature was performed using the PubMed, Google Scholar, Elibrary, and Scopus databases. We have included cases and case series of simultaneous rhinoplasty and endoscopic sinus surgery in the study. We analyzed the frequency of postoperative complications, patient satisfaction with cosmetic and functional results, the requirement for repeated operations due to recurrent CRS, the requirement for an additional correction of nasal appearance and the criteria for selecting ideal candidates for such surgical interventions. A concurrent rhinoseptoplasty and endoscopic sinus surgery is possible without reducing the effectiveness of each of these operations. However, there are no generally accepted guidelines on the procedure, on the surgical intervention volume, and generally accepted criteria for assessing the surgical risk are lacking. ронический риносинусит (ХРС) и нарушение носового дыхания достаточно часто сочетается с не- удовлетворенностью пациентом формой наружного носа. В связи с непрерывным развитием новых технологий, включая эндоскопическую синусохирургию (ФЕСС) и сохраняющую ринопластику (РП), встает закономерный вопрос о безопасности и эффективности проведения этих операций одноэтапно. Для понимания современных тенденций производился тщательный литературный поиск статей, опу- бликованных в базах данных PubMed, Google Schoolar, Elibrary, Scopus. Критерием включения в анализ было описание клинического случая, либо серии случаев одномоментного выполнения РП и ФЕСС. Производилась оценка и анализ частоты возникновения послеоперационных осложнений, удовлет- воренности пациентов косметическими и функциональными результатами, необходимости повторных вмешательств в связи с рецидивами ХРС либо потребности дополнительной коррекции формы наружного носа, а также анализ критериев подбора идеальных кандидатов для подобных вмешательств. Проведение риносептопластики одноэтапно с ФЕСС возможно без снижения эффективности каждого из этих вмешательств. Однако до настоящего времени нет четких общепринятых установок о порядке выполнения этих операций, об их объеме, а также о единых критериях оценки хирургического риска.

Abstract. The purpose of the article is to present current surgical approaches to the removal of frontal ethmoid osteoma. The article analyzes and describes surgical techniques used at the department of otorhinolaryngology of the Central Clinical Hospital and Polyclinic for the treatment of osteomas located in the frontal sinus, frontal recess and ethmoidal labyrinth roof. Headache and eye symptoms are the main manifestations of the disease. The method of choice for symptomatic osteoma is surgical removal of neoplasm. The article describes different types of interventions including external, endoscopic endonasal and combined approach. In external approach preference should be given to access with the formation of bicoronary osteoplastic flap. The methods is appropriate in cases when the patient is operated for the first time, the osteoma occupies the majority of the sinus or is located laterally thus making it impossible to remove it transnasally. If the patient underwent a frontal sinus surgery earlier and has a cosmetic deformity, it is feasible to resort to radical surgery on frontal sinus with fat obliteration. Endoscopic endonasal access is applied in cases where the osteoma is located in the roof of ethmoidal labyrinth or frontal recess, as well as in cases when the frontal sinus osteoma does not obstruct outflow and frontal sinusitis is caused by anatomical narrowing of nasofrontal junction. In asymptomatic osteomas watchful waiting is recommended.

Acute respiratory infections (ARI) constitute a group of acute viral diseases transmitted by droplet route and characterized by catarrh of the upper respiratory tract with symptoms of infectious toxicosis. ARVI is the most common infectious disease group with a wide range of infectious agents.

This work was designed to carry out the postmortem evaluation of the potential of using a multi-angle endoscope for endonasal surgical interventions on the ethmoidal and sphenoidal sinuses. The study was performed on 5 fresh cadavers (10 sides). It was shown that the range of the angles and directions of view during dissection of ethmoidal sinuses is 10-50 degrees and 360 degrees respectively. The use of an Acclarent Cyclops endoscope made it possible to visualize all walls of the sphenoidal sinus through the enlarged aperture which confirms the higher effectiveness of this instrument compared with the traditional endoscopes having the fixed angle of view of 0, 30, 45, and 70 degrees. The disadvantages of the Acclarent Cyclops endoscope are its heavier weight and a somewhat poorer quality of the screen image of the operative field.

РОССИЙСКАЯ РИНОЛОГИЯ, 4, 2014 Операции на верхнечелюстной пазухе (ВЧП) являются наиболее распространенными среди всех эндоскопических эндоназальных вмешательств на околоносовых пазухах (ОНП) [1]. Основная цель операции — восстановить вентиляцию и дренирование ВЧП путем расширения естественного соустья, что является основой ее нормального функционирования [2]. Классическим подходом к соустью ВЧП считается предварительная резекция крючковидного отростка (КО) [3, 4]. Вместе с тем многие хирурги не уделяют должного внимания именно этому этапу операции [5]. Вероятной причиной пренебрежительного отношения к резекции КО является то, что роль его до конца остается не ясной. Одни исследования показывают, что КО оказывает значительное влияние на вентиляцию как ВЧП, так и полости носа, другие не находят убедительных доказательств отрицательного влияния резекции КО на функцию ВЧП [6, 7]. Некоторые авторы предлагают doi: 10.17116/rosrino20142247-12

Computed tomography of paranasal sinuses (CT PNS) is used not only for diagnostics of chronic sinusitis but also as the principal tool for planning different stages and procedures of The algorithm for the assessment of the value of computed tomography prior to endoscopic interventions on the paranasal sinuses endoscopic endonasal intervention. Bearing in mind marked variability of anatomic structures of the sinoonasal region and its close proximity to other vitally important structures, it is crucial to perform a detailed assessment of CT PNS scans prior to endoscopic sinus surgery in the routine fashion and in conformity with the preliminary plan. In order to facilitate the analysis of the preoperative CT PNS data, the ten-step algorithm for scan assessment has been developed to be used for surgery planning and prevention of postoperative complications.