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In this review presents data on efficiency endoscopic operations at some ear diseases. Now endoscopic operations are widely applied at primary and residual (or recuring) middle ear cholesteatomas, tympanic membrane perforation, otosclerosis and cochlear implantation. Proceeding from resolving power of endoscopic technology, endoscopic operation can be applied as an independent method, or as an endoscopic assisted, to be combined with otomicrosurgery operation. Efficiency of endoscopic operation in many respects is defined by a possibility of panoramic visualization of anatomical structures of middle and inner ear, and also carrying out high-quality elimination of focus lesion from areas, being remote when performing otomicrosurgery operation.

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The objective of the present work was to study the specific endoscopic anatomical features of the middle ear using the dissected temporal bones with the intact tympanic membrane. The 18 cm long endoscopes 4 mm in diameter with a visual angle from 0 to 45 degrees in the combination with some other microinstruments, such as ear pincers, needles, curettes, elevators, and suction tubes, were used during the examination. It was shown that endomeato-transtympanic endosopy provides a panoramic view of almost all structures of the middle ear. After the resection of the posterior bone edge of 'annulus tympanicus', the use of the 45o endoscope ensured the panoramic view not only of certain structures of the middle ear (e.g. the tympanic chord, the stapedius muscle tendon, the entire pyramidal process) but also of the structures of the retrotympanic and anterior epitympanic spaces.

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The objective of the present work was to evaluate the outcomes of anterior craniofacial resection (ACFR) in the patients presenting with disseminated tumours and pseudotumour lesions in the nasal cavity, the paranasal sinuses, and the orbit based on the results of dynamic clinical observations. A total of 24 patients with tumours and tumour-like lesions of these anatomical structures were involved in the study including 14 ones having benign neoplasms, 2 patients with pseudotumour lesion, and 8 patients having malignant tumours. In all the cases, the pathological processes in the form of destruction and infiltration encompassed the anterior portion of the base of the skull (mostly lamina cribrosae) and spread directly into the anterior cranial fossa. It was shown that ACRF ensured the radical elimination of the pathological process and the enhancement of the five-year survival rate in all the patients with benign tumours and pseudotumour lesions and in half of the patients presenting with disseminated malignant neoplasms.

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Despite reports of successful treatment of oncological diseases of the upper respiratory tract, many patients with this pathology still apply for medical aid too late. Squamous cell carcinoma remains the predominant problem. Clinical symptoms of metastases are absent in 60% of the lethal cases with locally spreading tumours. The most common causes of death among these patients are obstruction of the upper air passages, invasion of tumour cells into the brain, local and systemic metastasis. It is concluded that the improvement of early diagnosis of malignant neoplasms of the upper respiratory tract and organization of specialized care for subjects with pre-tumor processes requires joint efforts of oncologists and otorhinolaryngologists. The achievement of this goal would enhance the effectiveness of the treatment of this pathology.

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Angiography was made in 30 patients with nasopharyngeal tumors. 22 of them had juvenile nasopharyngeal angiofibroma (JNA), 8 patients had early cancer. The analysis of angiograms has shown that coronary arteries system has a certain angiographic picture and characteristic anatomic relations with nasopharyngeal tumors. Changes in vascular picture suggest some direct and indirect angiographic signs pointing to the presence of vessels carrying blood to the tumor and are characterized by the following signs: disposition of the vessels, changed vascular caliber, vascular infiltration, newly established vascular net of tumor type and avascular zone in tumor stroma, delay of contrast substance in tumor stroma. Digital subtraction angiography has an essential role in estimation of possibility of collateral cerebral circulation in some patients with JNA advancing intracranially. For safe surgical intervention such patients need occlusion of internal carotid artery siphon.

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The authors has modified surgical policy in a basicranially extending form of juvenile nasopharyngeal angiofibroma (JNA) which is classified into tumors of stage I, II and III. Basally advanced tumors were diagnosed in 28 of 40 JNA patients: basicranially extended tumor (n=12, 30%), stage I tumor invading nasopharynx, nasal cavity, sphenoid sinus (n=4, 14.3%), stage II tumor invading nasopharynx, nasal cavity, sphenoid sinus, pterygopalatine fossa, ethmoid sinuses (n=9, 32.1%), stage III tumor invading nasopharynx, nasal cavity, sphenoid sinus, pterygopalatine fossa, ethmoid sinuses, infratemporal fossa, orbit, maxillary sinus and parapharyngeal space (n=15, 53.6%). Differential surgical treatment according to Owens (stage I tumors), Denker (stage II tumors), Moure (stage III tumors) provides radical removal of the tumor in the majority of the patients (87.7%) and therefore is an effective therapy of surgical treatment of the above patients.

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The author proposes a new policy of surgical treatment of juvenile nasopharyngeal angiofibroma (JNPAF) with intracranial growth based on differential application of combined operations in two variants depending on the direction of the intracranial growth. A total of 12 patients were operated. In 10 patients the tumor invaded some parts of the facial skeleton and lateral part of the cavernous sinus. A complete removal of the tumor in these patients was carried out at microsurgical operation on the base of the skull in combination with the modified operation by Moor. One of the patients died on postoperative day 2. In 2 of 12 patients the tumor infiltrated the cavernous sinus. Neurosurgical operation was made to occlude intercavernous parts of the internal carotid artery for achievement of a complete removal of the tumor in combination with two operations: microsurgical operation on the base of the skull and the modified operation by Moor. The author emphasizes special importance of application of special components of general anesthesia (controlled hypotension, dehydration therapy), some medical equipment (an operational microscope, a drill, diathermocoagulation and suction) and in some cases special preoperative preparation for a complete removal of the tumor.

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The oral part of the pharynx affected by cancer is subject to radiation, surgical and combined treatment. In stage IIIb the author practices resection of the oral pharynx by means of posterolateral pharyngotomy. This provides an adequate approach to the lesion area (the root of the tongue, vallecules, posterior and lateral walls of the pharynx) to perform ablastic resection of the oral pharynx with radical dissection of cervical fat.

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Laryngectomy has been performed as first-line treatment in 23 patients with laryngeal cancer stage III-IV. The author has modified the final stage of the surgery: laryngeal defect suturing with a continuous suture and the wound drainage. Two patients were operated on radically. Five-year follow-up covered 3, 3-year one 15 patients. None of them had recurrence or metastases. Healing by first intention was observed in 74% of the patients. It is inferred that laryngectomy is effective as an initial stage of combined treatment of laryngeal cancer stage III-IV. The modification of the surgery final stage reduces the frequency of postoperative complications in the absence of inflammation in the tissues adjacent to tracheostoma.

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