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Staging of tumors is very important in treatment and surgical decision making, as well as in predicting disease recurrence and prognosis. This review focuses on the different available classifications of juvenile nasopharyngeal angiofibroma (JNA) and their impact on the evaluation, management, and prognosis of JNA. The literature was reviewed, and publications on JNA staging were examined. Our MEDLINE search of the entire English-language literature found no review article on the current available staging systems for JNA. In this article, we review the common JNA classification systems that have been published, and we discuss some of their advantages and disadvantages. The most commonly used staging systems for JNA are the Radkowski and the Andrews-Fisch staging systems. However, some newer staging systems that are based on advances in technology and surgical approachesthe Onerci, INCan, and UPMC systems-have shown promising utility, and they will probably gain popularity in the future.

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Recurrence of allergic fungal rhinosinusitis (AFRS) is well recognized. However, there is scarcity in the literature describing involvement of the non-diseased sinuses. We aimed to evaluate the recurrence forms of unilateral AFRS as well as to study the possible predictor factors of developing the disease in the contralateral side. Patients with exclusive unilateral AFRS from (2010 to 2015) were enrolled in multi-institutional case-control study. All patients were evaluated after endoscopic sinus surgery for recurrence. Patient's records were reviewed for demographics, medical treatment, and clinical, radiological, and surgical data. A total of 68 patients were identified. Delayed contralateral involvement after the initial surgery was found in 30.8% with mean duration of recurrence 16.9 months. A significant association was found with the presence of pre-operative contralateral symptoms and signs of inflammation (OR 3.49, 95% CI 1.19-10.22, p value 0.02). Post-operative use of budesonide irrigation was associated with less contralateral involvement (OR 0.11, 95% CI 0.01-0.87, p value 0.01). Association of other variables like: comorbidities, perioperative use of systemic steroid, radiological signs, extent of surgery, additional surgery to the contralateral side, and post-operative use of systemic steroids did not show statistical significance. Involvement of the contralateral sinuses in 30% of unilateral AFRS cases is considered significant. The non-diseased sinuses should be involved in the routine endoscopic examination and post-operative treatment. Further studies are necessary to investigate the possibility of prophylactic surgical intervention of the non-diseased sinuses.

<p class="abstract"><strong>Background:</strong> Osteomas, ossifying fibromas, and fibrous dysplasia comprise a set of benign neoplasms known as fibro-osseous lesions (FO), which can arise in the paranasal sinuses. The vast majority of benign FO lesions (BFOL) are incidental findings on radiographs. They tend to be slow-growing tumors, and are infrequently symptomatic. The management strategy can vary significantly for theses lesions. This can range from serial, observations to aggressive surgical resection, based on symptomatology, size, and location of the lesion.</p><p class="abstract"><strong>Methods:</strong> Retrospective analysis of all the data of different symptomatic FO of the paranasal sinuses and the skull base was performed at King Fahad specialist hospital, Dammam, KSA (2006 to 2017).  </p><p class="abstract"><strong>Results:</strong> A total of 21 patients were identified; 10 (46.7%) patients were diagnosed with osteoma, 8 (38.1%) with fibrous dysplasia, 2 (9.5%) with ossifying fibroma and one (4.8%) with juvenile active ossifying (JAOF), 17 were adults and 4 were children, the range of f/u (3-60) months. 19 patients were managed by the endonasal endoscopic approach. They continue to be followed with no evidence of recurrence. Two cases required the revision combined endoscopic open approach to ensure adequate removal of the disease (residual and recurrence).</p><p><strong>Conclusions:</strong> Diagnostic dilemma of BFOL can be overcome with a combination of clinical, radiological and pathological criteria. Correct diagnosis of fibro-osseous tumors is crucial for adequate therapy as their treatment, prognosis, clinical aggressiveness and long term complications of individual entities vary significantly. Endoscopic computer-assisted surgery is the treatment of choice. Endoscopic resection remains a technical challenge. </p>

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