Endoscopic sinus surgery (ESS) has facilitated opening the frontal sinus, but, it still seems to be a tough procedure. This paper shows the safe and precise procedures for frontal sinus opening and its effectiveness. Our procedure is the anterior approach to attack the frontal sinus ostium while preserving the anterior-superior attachment of the uncinate process so that the middle turbinate is supported. In this method the key point is to identify the relation between the uncinate process attachment and the roof or medial wall of the ethomoidal bulla using a 70° endoscope. The wall of the ethmoidal bulla should then be removed from posterior to anterior, while keeping the anterior-superior attachment of the uncinate process intact, using giraffe forceps and a curved seeker.
From April 2004 until August 2005, 63 patients with chronic sinusitis were underwent frontal sinus opening with ESS at the department of Otolaryngology, Head and Neck Surgery, Ehime Prefectural Central Hospital. One hundred and fourteen sides of these patients were followed up after surgery for more than three months up to 792 days, with an average of 381 days, and the opening of frontal sinus was investigated using an electronic stroboscope at the time of final examination.
As for the result, open sinuses were observed in 99 sides (86.8%) and 26 sides of 39 sides (66.7%) with bronchial asthma were open. All of the closed frontal sinus were caused by polyp proliferation with no lateralization of the middle turbinate. This result suggested preserving the upper attachment of the uncinate process is helpful to keep the frontal sinus open.

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Objective: The purpose of this study was to predict the severity of symptoms in patients with Japanese cedar pollinosis based on the change in color of the inferior turbinate before the development of symptoms. Materials and Methods: In 189 patients with Japanese cedar pollinosis, the color of the inferior turbinate was assessed more than 1 month before, immediately before and during the pollen-scattering season. The severity of the disease was classified according to the Practical Guideline for the Management of Allergic Rhinitis in Japan, 2005. The color was assessed using the XYZ colorimetric reference system. Statistical analysis was performed with a two-way analysis of variance (ANOVA). Results: The color of the inferior turbinate mucosa differed significantly depending on the severity of symptoms and time of measurement, and was determined by an interaction between the two. The red color element of the inferior turbinate became deeper before the pollen-scattering season in those patients who subsequently developed severe symptoms as compared with those with moderate or mild symptoms. Conclusion: The severity of the pollinosis can be predicted based on the color of the inferior turbinate before the start of the pollen-scattering season. Those patients in whom the red color element of the inferior turbinate became deeper before the onset of the pollen-scattering season are likely to develop severe pollinosis.

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Tumors metastasizing to the head and neck are rare compared to primary tumors. We report a case of gastric cancer metastasizing to the nasal cavity. Only four cases of metastasis from a gastric lesion to the nose and paranasal sinus from gastric lesion have been report to our knowledge.
A 66-year-old man reporting nasal obstruction had undergone surgery. He had been operated on for gastric cancer histologically diagnosed as adenocarcinoma six years earlier. We excised a nasal tumor histopathologically consistent with adenocarcinoma. He remains well without lesion recurrence in the 20 months since surgery.

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We report six cases (three males and three females aged 5 to 85 years) with paranasal sinusitis and orbital complications seen at Mie University Hospital in the last 10 years. Based on the classification of Chandler et al, one case belonged to stage II (orbital cellulitis), three to stage III (subperiosteal abscess), and two to stage V (cavernous sinus thrombosis). All six patients decreased visual acuity and four had ophthalmoplegia. Except for one complicated by meningoencephalitis, five recovered from decreased visual acuity. Streptococcus species were isolated from three. Aspergillus and Propionibacterium were detected from a case who died of meningoencephalitis. A five-year-old boy was treated by antibiotic administration alone and either endonasal sinus surgery or an external approach was conducted in five.

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(Background) Smoking is harmful for respiratory epithelial function. Humidification is necessary for mucociliary clearance and maintenance of the liquid layer of the airway epithelium. There are few studies about the changes in transepithelial water loss (TEWL) and potential differences (PD) in the nasal mucosal epithelium associated with smoking. (Methods) Measurement of TEWL was performed on the inferior nasal turbinate. TEWL was measured with an evaporation meter based on Fick's law. PD was measured using the Ussing's technique. Anterior rhinomanometry and acoustic rhinometry were also conducted. (Results) Increased of the PD, significant decrease of TEWL and increase of the minimum cross sectional was observed after smoking. (Conclusion) Smoking leads to significant increase of the PD and decrease of TEWL in the nasal mucosa. Increased of the nasal patency was observed after smoking.

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Postoperative endonasal observation using an endoscope is recommended to assess the results of endoscopic sinus surgery (ESS). The effects of ESS are usually evaluated, however, using computed tomography (CT) or subjective symptoms because no appropriate endoscopic evaluation has been established. We propose postoperative endoscopic evaluation for patients with chronic sinusitis who underwent ESS and evaluated its feasibility.
We set up scoring of 0 to 3 points, i. e.) 0, normal mucosa and connection to the nasofrontal duct, 1, the presence of the pathological mucosa around the frontal recess, but connection to the nasofrontal duct 2, the presence of the pathological mucosa around the frontal recess, and closing the nasofrontal duct, 3, closing of ostiomeatal complex. We scored 26 patients (45 sides) who underwent ESS and observed postoperatively for six months. Dividing them into success and unsuccessful groups and comparing scores.
No significant difference was seen between groups within six months after ESS, but significant differences were seen there after that increased over time. We found the new scoring to be particularly useful in ESS evaluation.

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