الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
According to Draf, Hirschmann performed the first attempts at nasal and sinus endoscopy in 1901 using a modified cystoscope. In 1925, Maltz used the term sinuscopy and described techniques for endoscopic examination of the maxillary sinuses via both inferior meatal and canine fossa routes. It was not until the middle of the twentieth century, when Professor HH Hopkins developed the rod optic telescope and made the next major advancement using the endoscope of the upper airway (Theodosopoulos et al, 2010).
Endoscopes incorporating fibre optic light delivery and the rod optical system have markedly improved illumination and optical clarity, opening up the possibility of routine endoscopic examination of both the nasal cavity and the sinuses. This improved visualization of the sinonasal cavities and substantially responsible for reconsideration of the traditional concepts by Messerklinger and Proctor and for the development of new techniques for surgical management of paranasal sinus diseases (Stammberger and Posawetz, 1990).
Nasal endoscopy allows a thorough evaluation of intranasal anatomy and identification of pathology that is impossible to see using standard teqniques of anterior rhinoscopy by headlight or head mirror. It has proven more sensitive than computed tomography (CT) for the evaluation of the accessible disease and provide valuable information regarding persistent asymptomatic disease postoperatively (Jones et al, 2008).
Anatomically the paranasal sinuses comprise the maxillary, sphenoid, frontal and the ethmoid sinuses whose roof is formed by the frontal bone lateral to the cribriform plate and the crista galli in the midline.
Non contrast CT in different planes (coronal, axial and saggital reformatting) is considered the current standard to identify and evaluate details of sinus anatomy and pathology (Weber et al, 2003). The functional endoscopic sinus surgery (FESS) helps to re-establish drainage from the maxillary, ethmoid, sphenoid, and frontal sinuses. In addition, allowing the ostiomeatal complex to stay patent being an important factor in re-establishing mucociliary clearance from the dependant sinuses (Bublik et al, 2009).
Endoscopic sinus surgery boasts success rates of 80 % to 90%. However, there is a subpopulation of failures that will need to undergo further surgery. The majority of failures can be attributed to anatomic findings that lend themselves to surgical rivision with success rates from 69% to 78%. One must, however, be aware of other medical problems that may be complicating the patient’s sinus disease (Stankiewicz et al, 1996).
Failure is best managed by trying to determine the cause. It should first be determined whether the sinus problem was caused by polyposis, infection, or both; the possible reasons for failure should then be considered. The possible reasons for failure in the patient with polyposis include inadequate removal, postoperative infection, or systemic disease. The possible reasons for failure in the patient with chronic infection include retained infection, adhesions, ostial obstruction, ciliary dysfunction, an unusual infectious agent, chronic rhinitis, deviated septum, systemic disease, or environmental causes such as job or life-style (Levine, 1995).