DISEASES OF THE PARANASAL SINUSES

Anatomy of the SINUSES

Sinusitis

SINUSITIS

Sinusitis is the inflammatory condition of the mucous membrane lining of the sinuses. It may progress to pus formation.

Sinusitis may be acute and chronic.

• inflammation of the maxillary sinus is called maxillitis;

• inflammation of the ethmoidal sinus is called ethmoiditis;

SINUSITIS

• inflammation of the frontal sinus is called frontal sinusitis;

• inflammation of the sphenoid sinus is called sphenoiditis;

SINUSITIS

• hemisinusitis – the involvement all sinuses on one side into inflammation process;

• pansinusitis – all sinuses are involved;

• polisinusitis – several sinuses, but not all, are involved

SINUSITIS

For their origination sinusitis may be primary and

secondary. Primary sinusitis are rare diseases, they appear as result of trauma or allergy. But usually infection spreads to sinuses from other focuses.

SINUSITIS

Sinusitis may divided into:• Rhinogenous – infection spreads from the nasal

cavity. It is the most common way for infection and such sinusitis is the complication of the flu.

• Odontogenic – infection spreads from upper teeth. This way is typical only for maxillary sinus. The pathologic process may spreads from 4,5,6 cheek-teeth apex to the inferior wall of the maxillary sinus

• Traumatic• Hematogenic• Allergic.

PATHOGENESIS OF SINUSITIS

There are three main factors lead to the sinusitis development:

• The most important factor is the opening of sinus hole. It may be blocked due to different reasons. As a rule, the hole may be blocked by the swollen mucous membrane. The other reason may be an anomaly of anatomical structures. The retain of secret, decrease the pressure of oxygen contribute the bacteria multiplication.

PATHOGENESIS OF SINUSITIS

• The other important factor is the defect of self-cleaning mechanism of the mucous membrane of sinus. Bacteria, viruses damage the respiratory epithelium and cause the immobility of the cilia.

PATHOGENESIS OF SINUSITIS

Changes of secret quality are taken place in the development of sinusitis. Secret becomes more concentrated and stick and therefore it can not be eliminated from the sinus.

PATHOGENESIS OF SINUSITIS

There are two additional factors:

• Immunodeficiency.• Pathological changes

of nose and nasopharynx that make difficulties for normal outflow from the sinuses (septum deviation, hypertrophic rhinitis, adenoids).

SINUSITIS

ACUTE sinusitis are divided into:

• Catarrhal.• Purulent.• Necrotic.CHRONIC:• Purulent• Polyps of sinuses• mixed

Diagnosis of Acute Rhinosinusitis, Major and

Minor Factors Major Factors Minor Factors

Facial pain/pressure Headache

Facial congestion/fullness Fatigue

Nasal obstruction/blockage

Halitosis

Nasal discharge/ purulence/ discolored postnasal drainage

Dental pain

Hyposmia/anosmia Cough

Purulence in nasal cavity on examination

Ear pain/ pressure/ fullness

Fever  

SINUSITIS SYMPTOMSCommon symptoms:• rise in temperature• bad appetite• sleep disturbances• changes of the blood

(leukocytosis)Local symptoms:• Pain located in the affected

sinus.• Nasal obstruction.• Purulent discharge from the

nose.• Oedema of facial tissues.• Watering.• Smell disturbances (hyposmia).

DIAGNOSTICS

ONE-SIDED MAXILLARY SINUSITIS

ONE-SIDED ETHMOIDITIS

ONE-SIDED SPHENOIDITIS

CONSERVATIVE TREATMENT

• Antibiotics• Nasal decongestant• Mucoactive drugs• Symptomatic treatment• Puncture of the

affected sinuses• Physiotherapy• Treatment of the

affected tooth

PUNCTURE OF MAXILLARY SINUS

NASAL IRRIGATION

SURGICAL TREATMENT

1. Necrotic sinusitis2. Orbital complications

(abscess and phlegmon of orbit)

3. Intracranial complications (meningitis, brain abscess)

4. Rhinogenic sepsis5. Odontogenic sinusitis

combined with maxillary osteomielitis

SURGERY