Background: Fungal infections of the PARANASAL SINUSes in the immunocompetent patients are being recognized with increasing frequency. Infections are assigned in invasive and noninvasive forms.Materials and methods: In a retrospective study, a total 39 patients with suspected fungal SINUSitis were studied for causative fungal agents between 1994 and 2001. Diagnosis was confirmed by demonstration of fungi in direct preparations and culture techniques. Samples were biopsy specimens taken from the SINUSes or exudates from deep SINUS tracts.Results: PARANASAL SINUSes mycoses were proven in 18 patients, including 12 men and 6 women, their age ranging from 17 to 58 years. The most frequently isolated organisms were Aspergillus spp. and Candida spp. PARANASAL SINUSes infections by Cladosporium trichoides (bantianum) and Pseudallescheria boydii are reported for the first time in Iran from Pasteur Institute.Conclusion: In our series, Aspergillus flavus has been isolated more frequently than other agents.

We present a case of allergic fungal SINUSitis (AFB) in a 20-year old man with few months' history of bilateral nasal obstruction and discharge with unilateral proptosis that underwent maxillary antrostomy due to the mass in PARANASAL SINUSes. Histological examination of tissue showed branching fungal hyphae interspersed with allergic mucin without fungal invasion to soft tissue. The patient received local steroid for 4 months and had no problem during follow up. Fungal culture was performed and Bipolaris fungus grew. Although most dematiaceous fungal infections occur in immunocompetent patients, the incorrect diagnosis and insufficient treatment may be life threatening.

Introduction: Frontal SINUS mucoceles are the commonest among all PARANASAL mucoceles. With introduction of functional endoscopic SINUS surgery, surgeons prefer endoscopic management of SINUS mucoceles, but lesions that appear in the lateral part of the frontal SINUS can be difficult to access and often need external approaches.Case Presentation: We described a lateral frontal SINUS mucocele with intra-orbital extension, which was successfully managed by endoscopic SINUS surgery.Conclusions: Endoscopic SINUS surgery is the treatment of choice in most frontal SINUS mucoceles including lateral frontal mucoceles.

Introduction: The frontal SINUS is the most variable part of the PARANASAL SINUSes in terms of symmetry, anatomical features and degree of development. The aim of this study was to assess the morphometric changes of the frontal SINUS in cone-beam computed tomography (CBCT) images. Materials & Methods: In this cross-sectional study, 200 CBCT images were examined for anatomical variations such as the presence of frontal SINUS, SINUS symmetry, lateral frontal SINUS extension (LFSE) to orbital roof, scalloping, septum and type of septum. Moreover, Crista Galli (CG) was divided into three equal segments of anterior, middle and posterior in order to have a precise criterion for determining the location of the frontal recess in coronal plane. The data were analyzed using ANOVA with T-test and Chi-square at significant level of P<0. 05. Results: Of 200 cases, 113 and 87 ones were male and female with the mean age of 18‒ 88 years. The results showed that frontal SINUS was bilateral in all cases and symmetric in 113(57%) cases. The LFSE to orbital roof had a significant relationship with gender, so that at the external onethird, the LFSE was less frequent in women than men (P<0. 001). The most frequent location of the frontal recess was in the posterior one-third of CG (85 (43%)) with significant difference (P=0. 012). Conclusion: In this study, frontal SINUSes were rather symmetric, and the use of the anatomical CG marker in multiplanar (MPR) images was not feasible method for rapid detection of the frontal recess location in coronal plane.

Introduction: Mucoceles of the PARANASAL SINUSes are relatively rare. A very busy otolaryngology department does not have more than a few cases each year. Bilateral, multiple, and multiloculated cases are extremely unusual.Case Presentation: We report a 74-year-old man with two separate mucoceles in left ethmoid and frontal SINUSes with panSINUSitis. After marsupialization of mucoceles and functional endoscopic SINUS surgery, the symptoms of the patient relieved.Conclusions: Surgeons should consider the possibility of existence of other mucoceles when they find a large downstream SINUS mucocele obstructing the ostia of upstream SINUSes on computed tomography scans.

Purpose: To present a patient with radiation chiasma neuropathy, secondary to radiotherapy of PARANASAL SINUS lymphoma who was referred for evaluation of gradual decrease of vision in both eyes.Case report: The patient was a 38-year-old male, with history of right maxillary SINUS lymphoma, who underwent surgery, chemotherapy and radiation therapy. One year after radiotherapy, he noticed gradual decrease in his right eye vision. He referred to our center 6 months after onset of visual symptoms (1.5 years after radiotherapy). On his first examination, visual acuity (VA) of right eye was no light perception (NLP), and right optic disc was severely atrophic. Other examinations of right eye were unremarkable. The VA of left eye was 10/10 with correction, color vision was normal, slit lamp exam and tonometry was normal as well, but bow tie atrophy of left optic disc was detected. Visual field of left eye revealed temporal hemianopia. MRI showed thickening and enhancement of optic chiasm, especially in right side. In follow-up the enhanced lesion enlarged posteriorly and involved both optic tracts and optic radiations. In spite of treatment with high dose corticosteroid and hyperbaric oxygen, within two years following radiotherapy, vision of left eye gradually decreased to NLP too.Conclusion: Radiation-induced optic neuropathy is an important differential diagnosis of decreased vision in a case with history of head and neck radiotherapy. Since this complication is very important with ominous consequence, ophthalmologists and radiotherapists should be aware of that; and decrease the chance of its occurrence by lowering the dosage, daily fractionation, stereotactic methods, and precise aiming of radiation beam.