“Ladies and Gentlemen,

Distinguished Guests,

Dear Colleagues,

Good morning, I am delighted to welcome you all to Iran which has been the cradle of civilisation, science and art for many years, and it is my great pleasure to address this scientific international event.

The history of medicine in Iran is as old as and as rich as its civilisation. Not only the first charter of human rights has been written in Persia by Cyrus the Great but also regarding the historical records, the world's first medical conference was held upon Sassanid King's order in Iran in which hundreds of physicians from Persia and other countries attended there.

The practice and study of medicine in Iran has a long and prolific history as well. According to Cambridge History of Iran, Jundishapur University was the most important medical centre of the ancient world (defined as Europe, the Mediterranean, and the Near East) during the 6 and 7 centuries.

Iran's scientific and philosophical contributions to human civilisation have been significant. Among the torchbearers of ancient Persia’s scientific heritage are:

Avicenna, known as Prince of Physicians in west and chief master of all sciences in Muslim world whose medical book named Canon became the preeminent source of medicine among western medical scholars from early 14 to mid-16 century; and Razi who is well known as the discoverer of alcohol and vitriol (sulfuric acid).

Our contemporary medicine is a matter of honour as well. As the president of Iranian Medical Council which is the nation's largest independent organisation in the field of medicine representing almost all Iranian healthcare professionals, I am proud of my colleagues whose achievements made us a leading country in our region.

Despite of sanctions which faced our nation, not only maintained our health system in a standard level but also many scientific & outstanding achievements have taken place in this domain.

Undoubtedly through active international collaborations, our medical accomplishments flourish more.

Iranian Rhinologists promote excellence in the care of patients with disorders of the nose, sinuses and skull base and I highly appreciate their efforts and dedications for improving patients' lives.

Rhinology and sinus surgery have undergone a tremendous expansion since the discourses of Messerklinger and Wigand in the late 1970s. Imaging advances, increased understanding of the anatomy and the pathophysiology of chronic sinusitis, and image-guided surgery have allowed surgeons to perform more complex procedures with increased safety and minimally invasive way.

Rhinoplasty describes an array of operative techniques that can be used to alter the aesthetic and functional properties of the nose. In other words Rhinoplasty modifies the functional properties and aesthetic appearance of the nose through operative manipulation of the skin, underlying cartilage, bone, and lining. The incision type that the surgeon uses classifies the rhinoplasty as open or closed. In open rhinoplasty, the surgeon makes a small incision in the columella between the nostrils and then makes additional incisions inside the nose. Closed rhinoplasty involves incisions only in the interior of the nose.

Therefore surgical access to the nose can be gained via incisions placed inside the nose (endonasal approaches) or via incisions placed inside the nose combined with incisions placed outside the nostrils (external approach), usually on the columella. Prior to the increased popularity of the external (open) rhinoplasty approach in the last decade, the terms rhinoplasty and endonasal rhinoplasty were almost synonymous. This somewhat artificial division between external (open) and endonasal (closed) rhinoplasty has become an established part of current rhinoplasty nomenclature. Despite this, both approaches share many of the same incisions, and many of the same principles apply regardless of the approach chosen.

Proponents of endonasal rhinoplasty emphasize the following advantages:

Decreased need for surgical dissection

Decreased potential for nasal tip support reduction

Reduced postoperative edema

Corresponding decrease in the potential for overall scarring or iatrogenic insult to the nose

Ability to make exacting changes in situ

Via tactile palpation, a more immediate and predictable ability to feel changes made to the nose

Ability to make targeted improvements without taking the nose apart

Shorter operative times

Theoretical reduction in morbidity, especially in older patients

Elimination of any risk (however minimal) for developing a visible external columellar scar

Reduced postoperative edema

Quicker return to a normal appearance

The experienced rhinoplasty surgeon can use either an endonasal or an external rhinoplasty approach, based on the patient's rhinoplasty indications.

Rhinoplasties are increasingly popular procedures. A complex procedure, the rhinoplasty has in recent years seen changes of opinion in how this surgery should be performed, such as more attention to protecting or enhancing architectural integrity (Today it's important to maintain architectural integrity because noses change over time. Twenty years after surgery, noses don't look the way they did 5 years after surgery. The skin sleeve of the nose eventually gets thinner. Skin, the fat layer and muscle overlying the cartilage and bones must be considered as important parts which affect the outcome of rhinoplasty. Many rhinoplasties that were done 30-40 years ago and looked good a year after surgery don't look as good today because less attention was paid to preserving architectural integrity.) And like every other surgeries, there is a shift towards minimally invasive procedures.

On the other hand team work and active cooperation between plastic surgeons and other specialists and health care professionals in this domain will lead to better and more sustainable outcome mainly in facial reconstructive surgeries.

Outstanding short- and long-term results have been reported in the literature about Functional Endoscopic Sinus Surgery. Senior et al reported that symptoms improved in 66 of 72 (91.6%) patients following endoscopic sinus surgery, with a mean follow-up time of 7.8 years. In addition, endoscopic sinus surgery significantly influences quality of life; Damm et al reported an improvement in quality of life for 85% of their patient population, with a mean follow-up time of 31.7 months.

Although functional endoscopic sinus surgery is the primary approach used today for the surgical treatment of chronic sinusitis, the time-honored external approaches still play a role. Therefore, familiarity with endoscopic and external approaches, in conjunction with a precise understanding of the anatomy, ensures optimal patient care and outcome.

A recently developed alternative to functional endoscopic sinus surgery is balloon sinuplasty. This technique uses balloon catheters to dilate the maxillary, frontal, and sphenoid natural ostia without bone or soft-tissue removal. Reports show persistent patient symptom improvement and sinus ostia patency. Further study and long-term outcomes with this technology will determine its role in endoscopic sinus surgery.

Indications for Endoscopic Sinus Surgery

Endoscopic sinus surgery is most commonly performed for inflammatory and infectious sinus disease. The most common indications for endoscopic sinus surgery are as follows:

Chronic sinusitis refractory to medical treatment

Recurrent sinusitis

Nasal polyposis

Antrochoanal polyps

Sinus mucoceles

Excision of selected tumors

Cerebrospinal fluid (CSF) leak closure

Orbital decompression (eg, Graves ophthalmopathy)

Optic nerve decompression

Dacryocystorhinostomy (DCR)

Choanal atresia repair

Foreign body removal

Epistaxis control

Typically, endoscopic sinus surgery is reserved for patients with documented rhinosinusitis, based on a thorough history and a complete physical examination, including CT scans if appropriate, and in whom appropriate medical treatment has failed.

Medical therapy alone may be inadequate for treatment of nasal polyposis. Aukema et al found that although 12 weeks of treatment with fluticasone propionate nasal drops reduced the need for sinus surgery in patients with nasal polyposis and chronic rhinosinusitis, 14 of 27 patients still required surgery. Similarly, antrochoanal polyps require surgical removal.

Now let me underscore this scientific international educational congress.

The 5th International Rhinology & Facial Plastic Congress run by Iranian Rhinologic Society has brought together renowned national & international Otolaryngologists, plastic surgeons and scholars to an intensive and thorough educational congress focusing on Rhinology & Functional Endoscopic Sinus Surgery as well as facial plastic surgery.

Latest trends in this domain are offered to participants through active interaction with prominent international scholars.

Active international collaborative projects and events like the current congress have a key role in promoting the quality of medical practice and improvement of the medical education to a more excellent level.

Continuing Medical Education is an integral part of every health system to ensure that doctors are fit to practice.

If the CME course is held under the auspices of certified national and international medical organisations, it will benefit more both participants and lectures.

Scholars and lectures can amplify their knowledge by sharing experiences with their international counterparts attended there as faculty and participants will learn new trends resulting in more fitness to practice. As a matter of fact the quality of national healthcare will be improved considerably.

That is the true essence of global partnership for health which is enshrined in my objectives and schemes as the president of Iranian Medical Council as well.

I acknowledge Iranian medical specialists' achievements in this domain which is in accordance with world medical standards and I do believe that active cooperation with international prominent scholars in this domain will make us achieve highest possible standards.

A new chapter for global health partnership has been opened in the Iranian Medical Council since I and my executive board took office and I hope with the platform made by IRIMC International Affairs, the collaboration between Iranian doctors and their colleagues around the world is put in a new level.

Thank you for your time and attention.”

The scientific program of the 5th International Rhinology & Facial Plastic Surgery Congress was designed by Dr. B. Pousti who is a noted Otolaryngologist and the Treasurer of Iranian Rhinologic Society (IRS).

The Scientific Committee in concert with the renowned international Facial Plastic Surgery & Otolaryngology Academies brought together a stellar lineup of world-class faculty and speakers which made this congress the right place to get latest insights, new approaches and extensive educational programs for highest possible standards of professional medical practice in the field of Plastic, Reconstructive and Cosmetic Surgery of the Face, Head and Neck.

Internationally recognized otolaryngologists were among the main podium lecturers of this remarkable scientific event including Dr. Andrew A. Winkler, Assistant Professor and Director of Facial Plastic and Reconstructive Surgery Department of Otolaryngology of Colorado medical School, US and Dr. Alwyn D’Souza, specialist in ENT/Facial Plastic Surgery and the consultant surgeon at the University Hospital Lewisham, UK

Chaired by Dr. A. Razmpa, the 5th International Rhinology & Facial Plastic Surgery Congress came to end on 16 October 2015.

Dr. Shima Naghavi, Director of International Affairs