Isolated sphenoid sinusitis is a rare clinical entity with potentially devastating complications such as cranial neuropathies, cavernous sinus thrombosis, meningitis and intracranial abscess. It accounts for only 2.7- 3.0% of all paranasal sinus diseases.1A patient may present with myriad symptoms, ranging from occipital or vertex headache, retro-orbital pain, otalgia, drowsiness to meningitis-like symptoms. With these non-specific and varied symptoms, patients are usually not referred to an otorhinolaryngologist, which contributes to further delay in diagnosis and proper management. Prompt and accurate diagnosis is necessary in order to avoid catastrophic complications due to the proximity of the sphenoid sinus to vital neurovascular structures.

Nasal obstruction in neonates is a potentially fatal condition because neonates are obligatory nasal breathers. Bilateral choanal atresia is therefore a neonatal emergency. Several approaches for corrections of choanal atresia are available including the helium laser: YAG. A 5-year-old Chinese girl born with bilateral choanal atresia, had birth asphyxia that required intubation. She underwent multiple surgeries for correction of choanal atresia at other hospitals but failed to improve. She was referred to Universiti Kebangsaan Malaysia Medical Center (UKMMC) after presenting with intermittent respiratory distress and cyanosis following an upper respiratory tract infection. A repeat computed tomography (CT) scan done preoperatively showed complete bony stenosis over the left choana and finding was confirmed by examination under general anesthesia. She underwent endoscopic transnasal removal of left bony atretic plate. There was no intra or postoperative complications. During follow up 10 years later, the airway on both sides remains patent.