Tumors of the anterior and middle skull base represent a heterogeneous collection of neoplasms and lesions, the most common of these involving the pituitary. Surgery is often the mainstay of treatment with current trends favoring endoscopic, endonasal approaches when possible.

There are many pathologies that can affect the orbit and lacrimal system. These include nasolacrimal duct obstruction, Graves orbitopathy, complications from acute sinusitis, orbital apex lesions, and optic neuropathy. It is of utmost importance to understand the anatomy of the bony orbit as well as the fissures, foramens, and canals in which important neurovascular structures traverse. This will guide understanding of surgical technique and the exposure that is required.

There are a myriad of very diverse systemic diseases that can adversely affect the nose and sinuses. These include infectious conditions, autoimmune disorders, immunodeficiencies, and genetic diseases. These conditions can result in recalcitrant rhinosinusitis, rhinologic masses, and destructive sinonasal lesions. Performing a thorough history and physical examination is imperative, although there is significant overlap in the presentation of many of these disease processes.

Fungal rhinosinusitis must be categorized to optimize therapy and predict outcomes. This categorization is most dependent on the host’s immunologic status. Acute invasive disease occurs primarily in the immunocompromised patient and requires rapid recognition and rapid reversal of immunocompromised state if possible, systemic antifungals, and surgical debridement. The other forms of fungal sinusitis are usually chronic. CIFS is treated with long-term antifungals as well as surgical removal.

Frontal sinus surgery for refractory disease is one of the most challenging portions of endoscopic sinus surgery, due to its challenging anatomy and close proximity to brain and orbit. The Draf frontal sinusotomy procedures have been described as a stepwise approach to address frontal sinus disease with increasing complexity. In order to perform these surgeries safely, a thorough anatomic understanding is imperative to understand this complex region.

Patients with complaints of headache and facial pain are often referred to an otolaryngologist for diagnosis and management. The spectrum of causes of headache and facial pain is broad and many treatment modalities are available. The ability to use the appropriate diagnostic aids to determine the etiology of the pain is crucial in the otolaryngologist’s efforts to relieve pain and, in some instances, intervene in a potentially life-threatening event.

Benign sinonasal neoplasms represent a diverse group of pathologic entities. The most commonly associated symptoms include nasal obstruction, rhinorrhea, epistaxis, or facial pressure/pain. Comprehensive evaluation begins with a thorough history, physical exam, and nasal endoscopy followed by imaging. CT is typically utilized as the primary imaging modality; however, MRI can offer complimentary information in select cases. Biopsy provides diagnostic information and can aide in treatment planning.

Cerebrospinal fluid (CSF) rhinorrhea typically presents with unilateral anterior dripping of clear fluid. There are a number of possible etiologies. Understanding these etiologies and defining and localizing the skull base defect has implications on the perioperative, intraoperative and postoperative surgical approach and management. Despite the variety of repair options, the success of skull base fistula repairs are reported as over 80%.

Rhinoscopy / endoscopy is a critical component of the overall head and neck exam. This procedure is particularly important in any patients with nasal complaints or headaches. A variety of inflammatory, vascular, and neoplastic conditions affecting the nose and paranasal sinuses can only be diagnosed at early stages in this manner. The extent of disease as determined endoscopically, and further defined radiologically, will help in the planning of a definitive treatment.

Nasal obstruction is a common nasal complaint that may result from singular unilateral or bilateral anatomic perturbations. However, patients are commonly identified as having two or more factors working in concert to collectively impede nasal function. These may include combinations of septal deviation, fixed and dynamic obstruction of the internal and external nasal valves, and the effects of hypertrophied inferior turbinates.