ACUTE SINUSITIS

ACUTE SINUSITISLabeeb Pc

Roll no. 102

To Discuss..Anatomy of lateral wall of noseAnatomy of Paranasal sinusesPhysiology of Paranasal sinusesAetiology of a/c sinusitisa/c Maxillary sinusitisa/c frontal sinusitisa/c ethmoid sinusitisa/c sphenoid sinusitis

ANATOMY

Supreme turbinate

Basal Lamella

Uncinate process

Bulla Ethmoidalis

Hiatus Semilunaris

Infundibulum

Osteomeatal complexDrainage pathway for ant. group of sinusesMedially - middle turbinateLaterally - lamina papyracea Superiorly & Posteriorly- the basal lamella

1. Multiple bony structures - Middle turbinate, uncinate process, Bulla ethmoidalis2. Air spaces - Frontal recess, ethmoidal infundibulum, middle meatus3. Ostia of anterior ethmoidal, maxillary and frontal sinuses.

Osteomeatal Complex

Sphenoethmoidal recess: sphenoid sinusSuperior meatus: posterior ethmoid sinusesMiddle meatus:Frontal sinusMaxillary sinusAnterior ethmoid sinusesInferior meatus : nasolacrimal duct

Para Nasal Sinuses

Anterior GroupMaxillary SinusFrontal SinusAnterior ethmoidal

Posterior GroupPosterior Ethmoidal SinusSphenoid Sinus

The Ethmoid and Maxillary sinuses - birth. The frontal sinus - 2nd year

Sphenoid sinus - 3rd year

Functions Of Paranasal SinusesAir ConditioningResonance to voiceThermal insulatorsLighten skull bones

Maxillary Sinus ( Antrum Of Highmore)LargestPyramidalBase - lateral wall of noseApex zygomatic processCapacity 15mlNormal ostium posterior part of infundibulum

Roof floor of orbitAnterior wall facial surface of maxillaPosterior wall Infratemporal & Pterygopalatine fossaMedial wall middle & inferior meatusesFloor alveolar & palatine process of maxilla1cm below level of floor of nose

Frontal Sinus2nd largestRarely symmetrical..Thin bony septum

Anterior wall skin foreheadInferior wall orbitPosterior wall meninges, frontal lobe

Frontonasal duct Drains to Frontal recess, infundibulum

Frontonasal duct

Ethmoidal SinusesAnterior group middle meatusPosterior group superior meatus

Roof anterior cranial fossa( lateral to cribriform plate)Lateral wall orbit ( Lamina Papyracea )

Sphenoid SinusRarely symmetrical..Thin bony septumBelow sella tursicaOstium upper anterior wall ------- sphenoethmoidal recess

Relations.

Anterior part roof olfactory tract, optic chiasma, frontal lobe

Physiology Of Paranasal Sinuses

Ventilation & Mucous DrainageInspiration negative pressure emptiedExpiration positive pressure filled

Mucous from anterior groups lateral pharyngeal gutterPosterior groups posterior pharyngeal wall

Acute Sinusitis

Acute inflammation of sinus mucosa ---- < 3weeksMost common MaxillaryEthmoid Frontal Sphenoid

Multisinusitis PansinusitisOpen mucociliary mechanismClosed blocked ostium / viscous secretion

AETIOLOGY

Exciting causesNasal InfectionsSwimming & DivingTraumaDental infections

Predisposing CausesLocal CausesObstruction to sinus ventilation & drainageNasal packingDeviated septumHypertrophic turbinatesEdema of ostia Allergy / vasomotor rhinitisNasal polypiNeoplasm

Stasis of secretion in nasal cavityViscosity or obstructionPrevious attacks of sinusitis

General CausesEnvironment cold, wet, dust, smokePoor general health

MicrobiologyVirusesRhinovirus, Parainfluenza V, Coxsackie V, RSV

BacteriaStrept. pneumoniae, H.influenza, Moraxella catarrhalis, Strept. pyogenes, Staph. aureus & Kleb. pneumoniae

Fungi Mucor, aspergillus

Special syphilis, tuberculosis, leprosy

Pathologyhyperaemiaexudation of fluidoutpouring of polymorphonuclear cells increased activity of serous and mucous glands

Exudate serous mucopurulent / purulentEmpyema, destruction of bony walls

Acute Maxillary Sinusitis

Etiology Viral rhinitis Bacterial invasionDental infectionsPeriapical dental abscessRoot of tooth pushed to sinusOroantral fistulaDiving & swimmingTrauma

OROANTRAL FISTULA

Clinical FeaturesConstitutional symptomsHeadache foreheadPain - upper jaw gums,teeth..ipsilateral supraorbital regionTenderness - anterior wallRedness & edema of cheekNasal discharge Postural testHyposmiaPost nasal discharge

InvestigationHematology Transillumination testX-ray Waters view ( Occipitomental view )CT ScanDNE

Trans illumination test

Waters view

MAXILLARY SINUSESORBITSMAXILLAZYGOMA

Waters view

One-sided maxillary sinusitis

CT SCAN

MAXILLARY SINUS

SPHENOIDAL SINUS

Treatment MedicalAntimicrobials Nasal decongestantsSteam inhalationAnalgesicsHot fomentation

Surgical

Antral LavageLichtwitz trocar & cannulaLateral wall of inferior meatusIrrigate with normal saline

FESS

ComplicationsSub a/c or c/c sinusitisFrontal sinusitisOsteomyelitisOrbital cellulitis or abscess

Acute Frontal Sinusitis

Etiology Viral infections bacterial invasionDiving / swimmingTrauma Edema of middle meatusmaxillary / ethmoid sinusitis

Clinical FeaturesFrontal Headache ------ Office headacheTenderness floor just above medial canthusEdema of upper eyelidNasal discharge

InvestigationX-Ray - Waters & Lateral viewCTDNE

Lateral ViewWaters View

TreatmentMedicalAntimicrobialsDecongestantsAntihistamines + oral nasal decongestantCotton soaked in vasoconstrictor

SurgicalTrephination of Frontal Sinus2cm horizontal incision Floor exposed & hole drilled with burrPus taken for culture & sensitivityPlastic tube inserted & fixedIrrigate with normal saline until Frontonasal duct(FND) become patentRemove the tube when FND become patent

ComplicationsOrbital cellulitisOsteomyelitis .- Potts Puffy TumourMeningitis, frontal lobe abscess, extradural abscessc/c sinusitis

Acute Ethmoid Sinusitis

Clinical FeaturesPain medial & deep to eye..eye movtsEdema of lidsNasal dischargeSwelling of middle turbinate

One-sided Ethmoiditis

TreatmentMedical

Surgical External ethmoidectomy FESS

ComplicationsOrbital cellulitis & AbscessVisual deterioration & blindnessCavernous sinus thrombosisExtradural abscess, meningitis, brain abscess

Acute Sphenoid Sinusitis

Clinical FeaturesHeadache occiput / vertex.mastoidPostnasal discharge

D/D Mucocele, Neoplasms

Waters open mouth ( Pierres view )

SPHENOID SINUSMAXILLARY SINUS

ONE-SIDED SPHENOIDITIS

PreventionKeep nose as moist as possibleAvoid irritants such as smoke, dustAvoid long period of swimming in pools

Thank you

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